Youyou Tu

The Nobel Prize versus traditional Chinese medicine

oracknows — Mon, 12 Oct 2015 01:07:52 +0000

The Nobel Prize versus traditional Chinese medicine

Last week, in response to the awarding of the Nobel Prize in Physiology or Medicine to Chinese scientist Youyou Tu, who isolated Artemisinin and validated it as a useful treatment for malaria back in the 1970s, I pointed out that the discovery was a triumph of natural products pharmacology, not of traditional Chinese medicine (TCM). So did Scott Gavura, a pharmacist who blogs at my favorite other blog, Science-Based Medicine, who also emphasized that the path from TCM remedy for fever to pill used to treat malaria was the very model of how pharmacologists isolate medicines from plants. Basically, we both noted that Artemisinin is extracted from wormwood, but that the process of turning it into a drug involved a lot of trial and error, the elucidation of which wormwood plants contained enough Artemisinin to be useful for manufacturing larges amounts of it, and chemical modification fo the compound to make it more potent. None of this had anything to do with the basic ideas at the heart of TCM, such as the five elements or the imbalances in heat, damp, and the like to which TCM ascribes the cause of all diseases.

I hadn't planned on writing about this again unless some quack wrote a particularly juicy and stupid bit of nonsense about how Artemisinin proves that TCM works and the awarding of the Nobel Prize to Tu was finally an acknowledgement of that. It turns out that I didn't have to wait for that because there was an article in the New York Times over the weekend about just what I was talking about, the tension in China between TCM advocates who want to claim the Nobel Prize for Artemisinin as validation of TCM and Chinese scientists who will have nothing of these claims. It's a story about the Academy of Chinese Medical Sciences, where Youyou Tu did her work back in the 1960s through the 1980s and changed the course of Chinese science. The article lays out the essential conflict quite starkly:

Traditionalists say the award, in the “physiology or medicine” category, shows the value of Chinese medicine, even if it is based on a very narrow part of this tradition.

“I feel happiness and sorrow,” said Liu Changhua, a professor of history at the academy. “I’m happy that the drug has saved lives, but if this is the path that Chinese medicine has to take in the future, I am sad.”

The reason, he said, is that Dr. Tu’s methods were little different from those used by Western drug companies that examine traditional pharmacopoeia around the world looking for new drugs.

Why, I wonder, would Changhua be sad that Youyou Tu helped bring TCM into modern times? The answer is obvious. He believes in the whole system. That includes the whole set of prescientific concepts upon which TCM is based, including the five elements, which are believed to be the five aspects of qi, the life force or energy. Much like the case with the four humors in what I like to call traditional European medicine (i.e., humoral theory), it is "harmonious" balance between the elements that TCM teaches to be the basis of health. There are also six pernicious influences, the six excesses, or the six evils (e.g., wind, cold, heat, dampness, dryness) that are blamed for disease. There is also the concept that one can unblock blockages in the flow of qi using acupuncture needles.

And that's the problem. TCM is loaded with mystical pseudoscience. There are the vitalism behind the concept of qi, four humors-like nonsense of the five elements, and diagnostic silliness like tongue diagnosis, which is a lot like reflexology for the tongue, where specific areas of the tongue are claimed to map to specific organs, the way reflexology maps areas on the soles of the feet and palms of the hands to specific organs. Don't even get me started on pulse diagnosis. Yes, assessing the pulse can be a great aid in determining if a patient is dehydrated, possibly septic, or suffers from a heart condition that leads to irregularities in the heartbeat, but that's not what pulse diagnosis is about in TCM. There are 29 types of pulse in TCM pulse diagnosis, none of which really correlates convincingly to any physiological condition. There are notations such as how a "hesitant" pulse shows that "Blood and essence failing to nourish the meridians. Blood is not flowing smoothly." Physiologically, this is meaningless. As Steve Novella put it, pulse diagnosis and other aspects of TCM are excellent examples of knowledge disconnected from reality.

Now, of all the aspects of TCM, the one aspect most likely to produce useful treatments is the herbal medicines, for the simple reason that plants can contain chemicals that can be drugs. That's it. That was the case with Artemisinin, but I note that it took Tu's screening over 2,000 TCM herbal remedies for activity against the parasite that causes malaria. She tested various ways of extracting it from the plant. She chemically modified it. She had to figure out how to make it into pills. All of that is very different from this:

But the most sophisticated part of Chinese medicine, Dr. Liu said, involves formulas of 10 to 20 herbs or minerals that a practitioner adjusts weekly after a consultation with a patient. And yet almost no research has been done on how these formulas actually interact with the body, he said. Instead, the government has poured money into finding another Artemisinin — with no luck.

“Are we truly respecting this cultural heritage?” Dr. Liu said. “When we think Chinese medicine needs to be modernized and the path it shall go down must be like Tu Youyou’s path, I think it is a disrespect.”

Here's the problem. From a medical standpoint, the vast majority of TCM desn't deserve respect. We might respect it from a cultural and historical standpoint, but medically it's a prescientific system of medicine not based on science. If everything not rooted in science were to be stripped from TCM, all that would be left is the herbal medicine—and then only a small proportion of it, the herbal remedies that have thus far been shown by science to have uses, so far a vanishingly small number. It is that small part of TCM that might have value—if "modernized" and taken down Youyou Tu's path—that TCM advocates point to as proof that TCM as a system of medicine works.

Indeed, this is what some Chinese scientists themselves say:

But many Chinese think it should not be respected at all. Scientists like He Zuoxiu, a member of the prestigious Chinese Academy of Sciences, say that the ancient pharmacopoeia should be mined, but the underlying theories that identified these herbs should have been discarded long ago.

“I think for the future development of Chinese medicine, people should abandon its medical theory and focus more on researching the value of herbs with a modern scientific approach,” Dr. He said in an interview.

These radically different views on Chinese medicine go back at least a century, and get to the heart of how modern China sees itself.

It's been discussed in detail how Chairman Mao Zedong retconned the history of TCM in order to make it more palatable to his people after his Communists took the country over in 1949. What was a mish-mash of many different folk medicine traditions that included bloodletting as a precursor to acupuncture was transformed into a single system of medicine, which Mao sought to "integrate" with "Western medicine." One thing that the NYT article points out is that Mao also demanded that TCM "modernize," which it tried to do by setting up traditional Chinese hospitals, schools and research facilities like the academy in Beijing. After Mao's death, however, China invested far more heavily in "Western" medicine:

But money has flowed overwhelmingly toward Western medicine. In the Mao era, rural health care workers — “barefoot doctors” — were often traditional practitioners, which raised the profile of Chinese medicine. After Mao’s death and with growing prosperity, the government doubled down on Western medicine.

Today, China has 1.1 million certified doctors of Western medicine, versus 186,947 traditional practitioners. It has 23,095 hospitals, 2,889 of which specialize in Chinese medicine.

“It’s part of the nation, but the nation of China defines itself as a modern nation, which is tied very much to science,” said Volker Scheid, an anthropologist at the University of Westminster in London. “So this causes a conflict.”

In China, it would appear that TCM is dying. Fewer and fewer aspiring practitioners are becoming TCM practitioners; they want to become doctors instead. The government supports scientific medicine more than TCM. TCM advocates know it, which is why they latch on to this Nobel Prize to reassure themselves that it isn't so, that TCM is scientific, that it is now respected and embraced.

The sad thing is that China is moving in the right direction. In the "West," with the rise of "integrative medicine," which often wholeheartedly embraces TCM, we are going in the wrong direction.

oracknows Sun, 10/11/2015 - 21:07

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As a nuclear engineer and designer of Autonomous AI systems I have learned that the western method of scientific analysis is too narrow and inflexible to serve average society fairly. Western medice shows me mostly a failure of the scientific method. TCM offers a wealth of knowledge you might want to spend more time understanding because it has saved many more lives than it's killed and western medicine can't say that.

Michael, would you care to elaborate on these claims and provide sources, peer reviewed studies, or statistics that back them up?

Namely the claims that;
1) "the western method of scientific analysis is too narrow and inflexible to serve average society fairly,"
2) "Western medice shows me mostly a failure of the scientific method."
3) "TCM offers a wealth of knowledge."
5) "has saved many more lives than it’s killed."
5) and how, "western medicine can’t say that."

As a nuclear engineer and designer of Autonomous AI systems

And I'm Buckaroo Banzai.

Well, a respectable opinion. But where are the facts to back it?

Because Chinese medicine has not been involved with the development of vaccines, it is impossible for it to have saved more lives than medicine based on the ideology of science.

@herr doktor bimler: This man's a top scientist, dummkopf.

Science-based medicine does have negative points too. Within a herbal medicine there are a vast number of pharmacologically active chemicals, working together to solve the problem. However, in science-based drug discovery it is difficult (costly!) to get multiple chemicals approved for use. In this case, probably 10-20 different chemicals in wormwood would have been identified as efficacious in the treatment of malaria, but only the best one brought forward for human trials.

[TCM] has saved many more lives than it’s killed and western medicine can’t say that.

Are bears', tigers', rhinos' and deers' lifes accounted for, in your tally?
Because the harvest of these animals' ingredients is often plain torture, and it's happening as we speak.

"Western" medicine had a period like this not so long ago, but we put some effort since last century into improving the ethics of everybody involved.
And at least, whatever we learn from our lab animals, a good part could be put back into veterinarian medicine. TCM cannot say that.

This man’s a top scientist, dummkopf.
I had no idea that Yoyodyne Systems were expanding into the the Autonomous AI market

But the most sophisticated part of Chinese medicine, Dr. Liu said, involves formulas of 10 to 20 herbs or minerals that a practitioner adjusts weekly after a consultation with a patient.

Sounds like the leeches are onto a nice little racket there.

@ Dr Will

Within a herbal medicine there are a vast number of pharmacologically active chemicals, working together to solve the problem.

Objection, your honor. The witness is making assumptions.
He has conveniently decided that all of these pharmacologically active chemicals are beneficial.

@Dr Will,

In this case, probably 10-20 different chemicals in wormwood would have been identified as efficacious in the treatment of malaria

Why do you think that?

He has conveniently decided that all of these pharmacologically active chemicals are beneficial.

He's also decided they work together instead of inhibiting each other.

Post number 1 was made by an autonomous AI system probing us with a self-designed Touring test. Also SkyNet will become fully functional in T minus 30 minutes.

Have a nice day.

But the most sophisticated part of Chinese medicine, Dr. Liu said, involves formulas of 10 to 20 herbs or minerals that a practitioner adjusts weekly after a consultation with a patient.

And how does the practitioner know what adjustments to make? Is there some systematic approach, or is it a WAG?

And yet almost no research has been done on how these formulas actually interact with the body, he said.

So it's the latter, then.

No wonder the Chinese are voting with their feet and preferring science-based medicine to TCM. Even though the Chinese at least have the excuse of TCM being part of their culture. Westerners have no such excuse.

And as for our troll:

I have learned that the western method of scientific analysis is too narrow and inflexible to serve average society fairly.

Show us some evidence that your proposed system (of which you have provided no details) actually works better in this regard, and we might listen. But only if your system accepts reality as a constraint. If it doesn't, it's guaranteed not to work. I'm not saying that the scientific method is perfect (no system is; life is unfair), but it does accept reality as a constraint, and I am not aware of a better method.

the western method of scientific analysis is too narrow and inflexible to serve average society fairly.

Speaking as a (former) rocket scientist, it looks to me like you're mixing apples and oranges. Scientific analysis serves science just fine. It doesn't work as well for the rituals and beliefs that the average population loves, but it doesn't need to.

Post number 1 was made by an autonomous AI system probing us with a self-designed Touring test.

Would a Touring test involve participating in a conversation as though it were on a trip to Paris?

@Helianthus @Mephistopheles O'Brien

You're certainly correct. Whether chemicals act in a synergistic or antagonistic manner is unknown... but you could have a much more powerful technique for treating malaria held back by the difficulties in bringing a drug to market.

Biological organisms are highly robust. Objectives are approached through multiple pathways to ensure aims can be achieved. A good example is marijuana. The plant produces 57 (when I last looked) psychoactive compounds, rather than solely delta-9-THC.

@ Nuclear Engineer
With TCM, no risk of Hiroshima.

Objectives are approached through multiple pathways to ensure aims can be achieved.

What is this even supposed to mean? Is the sheer number of compounds produced by the plant sufficient evidence for you that the whole plant is more effective than the pharmaceutical form?

You’re certainly correct. Whether chemicals act in a synergistic or antagonistic manner is unknown… but you could have a much more powerful technique for treating malaria held back by the difficulties in bringing a drug to market.

Such as?

I mean, obviously, it's much easier to just believe a treatment has safety and efficacy than it is to demonstrate it. But that's hardly an argument against going the difficult route.

Biological organisms are highly robust. Objectives are approached through multiple pathways to ensure aims can be achieved. A good example is marijuana. The plant produces 57 (when I last looked) psychoactive compounds, rather than solely delta-9-THC.

It's not really clear to me how the points made in those four sentences constitute an argument for the superiority of herbal medicine.

I get the "biological organisms are robust and complex -- for example, marijuana!" part. But where do the medical applications come in?

@AdamG --

I had trouble with that, too. I think the presumption is that any process that sustains life in any way for some biological organism therefore sustains life in every way for all biological organisms.

Biological organisms are highly robust. Objectives are approached through multiple pathways to ensure aims can be achieved.

True enough. Were I designing a medicinal herb it would contain multiple chemicals that would work synergistically to selectively kill parasites, strengthen the immune system, and leave your breath minty fresh.

However, the primary purpose of these chemicals in the plant are not to benefit you. It is certainly possible that there are chemicals other than the one identified as most effective that would also be great choices (either alone or in combination) for treatment. It may make sense to continue looking into those. However, there's no particular reason to think that the whole plant will necessarily contain chemicals that work together to solve your problem.

Dr Will
And the marijuana plant's "objectives" are not similar to those of the person smoking it--so all those varieties of THC can have complex and contradictory effects on a human.

Have you any examples where complex drug mixtures were indeed more effective than a single optimized component? (Hint --it's not the two that were honored in this Nobel).

As far as marketing goes, in this case it didn't stop Novartis scientists from making a better drug for treating malaria by modifying the original version of artimisinin. The original wormwood compound exhibited too rapid clearance (very quickly flushed out of the body). Novartis currently donates the drug.

I'm absolutely putting "Objectives are approached through multiple pathways to ensure aims can be achieved." into my 'reasons not to use passive voice' slide.

Passive voice is employed, and obfuscation is achieved.

@MOB #17--I didn't say it was a well-designed Touring test.

A Touring test is surviving 12 countries in 14 days. A Turing test is something different.

"And I’m Buckaroo Banzai."

May I please have your autograph? When is your next movie? I've been waiting a long time.

"TCM offers a wealth of knowledge you might want to spend more time understanding because it has saved many more lives than it’s killed and western medicine can’t say that."

One of the true beginning points for scientific western medicine was began by Dr. Semmelweis. Dr. Semmelweis found that more mothers survived child birth if a midwife attended the birth than if a doctor attended the birth. He found that midwives normally washed their hands before delivering a baby while doctors seldom if every did. It took time for this idea of washing hands before delivering a baby (and at other times) caught on.

Because fewer mothers died during childbirth, the mothers were able too have more children. This concept of washing hands lead to the population boom. Thus we can say that western medicine has saved far more people than TCM every has.

Objectives are approached through multiple pathways to ensure aims can be achieved.

Is your doctorate by any chance from a business school? I ask because I rarely hear such pure MBA-speak. A sentence like that belongs in one of those trendy books about business success--you know, the ones that invariably miss the actual point in order to bolster the author's preconceived notions.

What we know about artemisinin is that it, and only it, had anti-malarial properties by itself. That's not too surprising: wormwood is not itself susceptible to malaria, so any anti-malarial effect would be, from its point of view, a side effect. Other compounds present would have other effects, if any. True, some of those effects might be beneficial, but treating malaria--the goal of Tu's study--was found not to be among them.

I'll repeat: Artemisinin is accepted as a treatment for malaria because it was found, by the methods of science-based medicine, to be a safe and effective treatment. If and when some other compound derived from TCM herbal treatments is found to be safe and effective for the treatment of some other condition, it too will be accepted as a treatment. As would compounds discovered by any other means.

How deliciously absurd! That the West should be welcoming with open arms the nonsense of ancient Chinese Medicine, having long abandoned ancient Western nonsense - the four humours, etc - at the very same time as China is abandoning historical nonsense and switching to science. Presumably they will be adopting all the egregious pre-scientific rubbish-medicine discarded by the West in the fullness of time.

Dr Will@7: So how many herbalists does it take to change a lightbulb anyway?

Artemisinin is accepted as a treatment for malaria because it was found, by the methods of science-based medicine, to be a safe and effective treatment

And Dr Tu found it by consulting the Chinese herbalism manuals as a guide to what not to do.

My bad. Looks like I was semi-autonomous this morning in my own postings and not even cognizant enough to pick up on the first hint by MOB. I'm going to go write "I will not confuse "Touring" with "Turing" one hundred times on the chalk board.

Chris Hickie - I suggest visiting sites important to Alan Turing's lifetime to drive the point hoem. There's a guidebook out for that - "Touring Turing".

I wish I'd come up with that first, but at least I came up with it independently.

Chris@33: I would have been prepared to believe that the Turing/touring confusion was due to Autocorrect. (Although, trying it here as an experiment, I see that my spell checker doesn't draw the red line under either version.) I leave Autocorrect turned off, for fear that something very much like that will happen in my writing. I work in a field where papers are normally cited as First et al. (20xx), or First and Second (20xx) if there are exactly two authors, so it's something I have particular need to watch out for.

a self-designed Touring test

Wait, someone's solved the Travelling Salesman problem?

I wouldn't be too sure about China giving up TCM - not when there's money to be made: look at this article from China Daily: http://www.chinadaily.com.cn/silkroad/2015-10/09/content_22136828.htm.
It even includes the scary paragraph: "The reason why foreigners don't understand and accept TCM is that they don't know its mechanism," Che said. "Each western medicine has an instruction, telling patients its components, function, dosage, mechanism and contraindication, but TCM doesn't. I want to be a translator of TCM, finding out the mechanism of TCM from the angle of molecular biology, so that TCM can be exported to more countries and benefit more people".

I'm not sure this story indicates that TCM isn't in decline. It just shows one company is doing well.

The reason why foreigners don’t understand and accept TCM is that they don’t know its mechanism

AFAICT the Chinese don't know the mechanism on TCM either. And I have little confidence that this Dr. Che will find such a mechanism. That's because much of TCM is based on a pre-scientific understanding of human physiology. So was Western medicine about 200 years ago. And I doubt that TCM comes without instructions--maybe the instructions are contradictory, but they are there. Likewise components, function, and dosage: there may be conflicting theories based on which version of TCM you use, but there ought to be some guidelines there. Mechanism and contraindication, I'll grant him, are not present in TCM, but he says this like it's a good thing. Most drugs have circumstances under which you should not use them (or use them with extreme caution)--allergies, for instance, or interactions with other drugs the patient might be taking.

Dear Orac:

You say the discovery of Artemisinin doesn't show triumph to TCM and rather it is a triumph of natural products pharmacology. However, the discovery of Artemisinin by Tu You You is ultimately credited to the historical texts in TCM, namely Huang Di Nei Jing and more specifically Zhou Hou Bei Ji Fang. By saying the credit for this discovery is not due to "TCM" you pretty much discredit the same significant historical texts that laid down the foundations of TCM theory as well as hinted to us 2000 years later about Artemisinin.

I don't think you're in a position to criticize "TCM" as broadly as you put it because you obviously show no real interest in the history of development and hardship throughout the history of TCM, otherwise you would not criticize TCM theory so lightly as you do. That's why Tu You You was awarded the Nobel Prize and found a treatment for malaria and you did not. The difference between you and her is that she showed genuine interest and found value in TCM, theory and text.

While you and others like yourself are writing articles that somehow differentiates "TCM" and "natural products pharmacology", as important and life-changing as it seems, others are discovering modern usages for traditional medicines and treating a disease that affects 300-500 million people each year by taking time to understand TCM theory and reading TCM texts. I think if you spent as much time writing these politically charged articles as reading and understanding TCM, you could have been making new discoveries you could not have imagined.

One last note: don't tell readers what or who to respect if you yourself are trying to earn respect by putting others down. It never works.

@Jordan C

What utter hogwash.

Giving credit to TCM makes about as much sense as crediting Dr. Tu's mother for the discovery, since she gave birth to her. TCM did not figure out which of their 2000 fever remedies actually worked, nor did TCM figure distill out the single most active ingredient, nor did TCM figure out which strain of the plant actually had useful amounts of this ingredient, nor did TCM chemically modify this ingredient into a form that actually allowed it to treat malaria. And TCM certainly didn't carry out clinical trials to prove that this drug was safe and effective.

TCM's only role here was throwing enough random herbs at enough random diseases that something was bound to have an effect, not that TCM practitioners would have been able to recognize it.

Orac made it very clear that he fully supports this sort of research: the mining of TCM literature for the scant few rememdies that actually have some effect, and bringing the full force of Science to bear on those remedies to turn them into safe, proven medications.

It is entirely possible to support that research, without clinging like a diehard fanatic to the 99.95% of TCM that is totally worthless if not harmful, which is exactly what Professor Changhua would like us to do.

There's one piece of ancient Chinese wisdom that might be useful here, which is the martial arts principle of using one's opponent's inertia against him/her.

In this case, something like what Orac said, or something along the lines of "sure, indigenous or ancient pharmacopoeias often point to medicinally useful plants. If you have any herbs you think have medicinal properties, we'd be glad to promote research to find out how and why they work, and turn them into medications that people can use safely and reliably..."

In other words, anyone who wants to be taken seriously is welcome to join our team and play by the same rules as anyone else.

This will rapidly sort out the honest from the dishonest. Even if the honest are misguided, they can be taught. The dishonest will keep sputtering and fuming and exposing themselves for what they are.

I'm still waiting to hear what Mike Adams is going to do with the Nobel news;-)

TCM’s only role here was throwing enough random herbs at enough random diseases that something was bound to have an effect, not that TCM practitioners would have been able to recognize it.

I suspect that Dr Tu would have reached useful results earlier and with less effort if she had ignored the Chinese-herbal pharmacopeia completely and just tested toxic plants systematically.
But the authorities wanted a vindication of TCM, so that's how she had to work.

I'm still trying to figure out how 'average society' is defined. Are we talking mean, median or mode? What are we measuring? Are societies +/- 2 standard deviations from the 'average' served better or worse? Is it a standard bell curve or not?

Inquiring minds want to know!!

If TCM is anything like Western Medicine, there are effective doctors, mediocre doctors, and horrible ones.

One should be able to look at the results from individual doctors, and figure out which doctors (therefor techniques) are most effective vs. least effective. (normalizing by demographics, etc)

And if all the variation is attributable to chance, then we have learned there is no substance to the practice. If we find the opposite, we may shed light on some previously hidden aspect of health.

I suspect that Dr Tu would have reached useful results earlier and with less effort if she had ignored the Chinese-herbal pharmacopeia completely and just tested toxic plants systematically.

That is exactly what I was thinking. It is quite conceivable that plants already omitted from the pharmacopoeia, because of side effects like death, would be at least as good or better candidates for killing parasites. Perhaps a decoction of water hemlock or black henbane (both out of season here, but back in the spring). In many cases, testing plant derivatives seems to me to be pretty much testing inconvenient mixtures of ready-made organic compounds. I suppose it is somewhat simpler than starting with a great big bucket of benzene and a box of bits to decorate the rings.

Does TCM even allow for the concept of parasites, at least those that are not macroscopic?

Jordan--

Hardship is irrelevant to whether a theory is valid, or whether a technique works. How long it takes to figure something out is partly chance. Would you call artemisinin less valuable if wormwood had been the first plant Dr. Tu tried?

Also, if you think artemisinin supports the theory of TCM, surely the two thousand useless substances that it also suggested as malaria cures are two thousand equally strong arguments against it.

When I hear of Western medicine, this kind of picture comes to my mind:
https://commons.wikimedia.org/wiki/File:A_quack_doctor_selling_remedies…

Contrary to the report in the New York Times, there is zero evidence that the plant from which the parent compound for artemisinin was derived was ever used to treat malaria. But then, when it comes to medicinal plants, the mainstream press rarely get's the facts correct.

While the discovery of artemisinin emphasizes the value of mining old texts for drug leads, or what is known in pharmacology as pharmacopoeial research, as part of the task, TCM theory is only of value in identifying potential activities.

While it would be absurd to say that TCM has a single "mechanism", according to various theories applied in the practice of TCM, certain plants are contraindicated, either in combination with others or in certain TCM diagnoses, all of which must be questioned in accordance with scientific evaluations, without which they will continue to be historical novelties of declining acceptance.

@Doug: TCM incorporates any number of western diagnostics, including parasites. Going back centuries, Chinese medicine had concepts of what we known today to be similar to parasites, and 'toxic' plants for their treatment.

Eric Lund@29:

AFAICT the Chinese don’t know the mechanism on TCM either. And I have little confidence that this Dr. Che will find such a mechanism.

Oh, I think he's already found it. Western medicine has its ion transport channels; TCM has its gold transfer pumps.

It's about the only mechanism that ALL alt-medders DO agree on.

Lighthorse # 49

Even if I don't know anything about TCM, I am nearly sure that ancient Chinese physicians could not know there was a disease such that, when blood from a feverish patient was examined, it showed ring- or banana-shaped parasites inside red blood cells. Today we call it malaria, using an ancient Italian word.

It is only a coincidence that a chemical derivate of a substance present in one of who-knows-how-many herbs used to treat "fever" is able to cure that disease.

Jordan C @40: You have obviously never read the texts you are talking about. Huang Di Nei Jing, which translates into "The Inner Canons of the Yellow Emperor", is traditionally attributed to the legendary Yellow Emperor who was said to have to founded the Chinese state around 5000 years ago, but is more likely to have been composed in the Classical era of Chinese history. In any case, it could have been compiled by no later than the Han Dynasty, seeing that it was catalogued in the Book of Han (Han Shu). The Zhou Hou Bei Ji Fang is a later book, written in Jin dynasty, which heavily cites Inner Canon of Bian Que, another medical manual mentioned in the Book of Han. The Artemisium formula, however, had no citation.

Besides, I challenge you to hold onto your admiration after you read some of the other formulas the Zhou Hou Bei Ji Fang lists for treating fevers. Mixing a spider into a ball of food and swallowing it was not the most ridiculous one.

Herr doktor bimler @32, 43: Based on your comments on this and the last article on the topic, I think you might have misread the reports. The Handbook directs the practitioner to steep the plant in water (non-boiling; the book clearly differentiates between boiling and steeping), which suggested to Dr. Tu that perhaps the boiling method of extraction was a problem.

I don't think it's efficient to test random plants (particularly random toxic plants, as doug@45 suggests) for anti-malarial activity. If you use crude extracts, there is no reason to think that anti-malarial effects will appear before the test subject is killed by other secondary compounds. If you use purified derivatives, well, that's an awful lot of chemical separation and trials.
From what I've read, I think Dr. Tu's team did a very primitive meta-analysis by rounding up a bunch of formulas for fever treatments, counted up the number of times each plant occurred in the formulas, and ordered the plants in terms of frequency. If this is the case, they might have identified Artemesium as a strong candidate early in the process.
I think your claim that Dr. Tu's project was political is unfounded. Based on the Wikipedia entry, https://en.wikipedia.org/wiki/Project_523, the project also had a branch concerned with synthesizing new compounds. This branch wasn't just for show either, seeing that it resulted in the creation of anti-malarial drugs such as pyronaridine.

Herr doktor bimler @32, 43: Based on your comments on this and the last article on the topic, I think you might have misread the reports. The Handbook directs the practitioner to steep the plant in water (non-boiling; the book clearly differentiates between boiling and steeping), which suggested to Dr. Tu that perhaps the boiling method of extraction was a problem.

Many thanks for the information and the correction.

The first thing you mention about "5 elements" in chinese medicine is a wrong translation. It's literally called "5 categories" in chinese language. It was wrongly translated to "elements" due to the old Indo-European alchemy believes which has nothing to do with the Chinese "5 categories". It's very sad that nobody questioned the translation.

As to Qi, we cannot prove it exists by using recent technology yet doesn't mean it's bullshit. Can you find any solid prove which says it doesn't exist? This kind of "if I can't prove it, then it's wrong" attitude is very unscientific. The same attitude killed countless scientists who said earth is round centuries ago.

One final advice, it's something a quantum physics professor said in a class. If you want to judge something, learn it thoroughly first. Finding unproven information online to compose an article to support what you believed is superstitious.

Tu's document clearly said she got the idea about how to extract Artemisinin from a several hundreds years old TCM book, and this method has been one of the medicines which TCM doctors used to treat malaria. According to other TCM doctors, there are several other TCM herbal combinations can treat malaria and even more efficient than using wormwood.

Jerry: "As to Qi, we cannot prove it exists by using recent technology yet doesn’t mean it’s bullshit." and "One final advice, it’s something a quantum physics professor said in a class. If you want to judge something, learn it thoroughly first"

So is Qi an energy? To see how well you understand energy please tell us what the difference is between kinetic and potential energy, and how they are related.

Jerry, it's not 'Qi,' it's obviously magical invisible curative nurse fairies!

As to Qi, we cannot prove it exists by using recent technology yet doesn’t mean it’s bullshit. Can you find any solid prove which says it doesn’t exist?

As to magical curative Nurse Fairies, we cannot prove they exist by using recent technology yet that doesn’t mean it’s bullshit. Can you find any solid prove which says they don't exist? The same attitude killed countless scientists who said earth is round centuries ago.

One final advice, it’s something a quantum physics professor said in a class. If you want to judge something, learn it thoroughly first.

Let's put this horrendously misquoted Feynman line in it's full context, shall we?

You'll have to accept it. It's the way nature works. If you want to know how nature works, we looked at it, carefully. Looking at it, that's the way it looks. You don't like it? Go somewhere else, to another universe where the rules are simpler, philosophically more pleasing, more psychologically easy.

Jerry, scientific method = it doesn't exist unless you can prove it.

As to Qi, we cannot prove it exists by using recent technology yet doesn’t mean it’s bullshit. Can you find any solid prove which says it doesn’t exist?

Of course, since Qi is not well defined, any proof that it doesn't exist is trivially "wrong": "No, that's not what we mean."
That's one reason why the original claimant has the burden of proof: part of the burden of proof is the burden of definition. If ever Qi is shown to exist, the 'proof' will carry the definition of what's being 'proven'. When and only when such definition is available, the question of 'disproof' becomes meaningful.

Come back when you have (a) a definition of some phenomenon of the universe that's distinguishable from all other phenomena, that (b) has properties that map onto the properties identified with Qi, and that (c) can be repeatedly, reliably demonstrated. Then, we can all look at what you've done and figure out what it really is.

As to Qi, we cannot prove it exists by using recent technology yet doesn’t mean it’s bullshit.

Bertrand Russell would like to sell you a teapot.

As to Qi, we cannot prove it exists by using recent technology yet doesn’t mean it’s bullshit. Can you find any solid prove which says it doesn’t exist? This kind of “if I can’t prove it, then it’s wrong” attitude is very unscientific. The same attitude killed countless scientists who said earth is round centuries ago.

In addition to what was already said by Chris, AdamG and Bill Price :
- We might not be able to measure Qi directly, but we should be able to measure its effects, for example by proving that therapies based on it work ; this effect is measurable.
- Can you tell me the names of the scientists who were killed because they said Earth is round ? And if you can find them, did their detractors really think “if I can’t prove it, then it’s wrong” ?

The same attitude killed countless scientists who said earth is round centuries ago.

I assume that Jerry is referring to all those flat-earth skeptics who set out to prove their absurd "spherical" model and fell off the edge.

No offense to the blind, but how can you make those who were born blind truly understand red, blue, green and color in general? Often times, the TCM deniers sound so much like the blind trying to deny the existence, or, more accurately, the experience of color (again apologies to the blind; this is an analogy only).

Worse still, these TCM deniers 1) purposely put on the blinders that make themselves blind to the myriad of evidence (unlike the blind who have no way of seeing color); 2) most of the deniers are not even qualified to make an educated judgment of TCM: If you want to criticize the the string theory as hogwash, you must first have a Ph.D-level in-depth understanding of theoretical physics; you are not qualified to attack it after perusing a few pop science books or spend a weekend surfing the net reading up on they lazy man and the dummy’s guide to theoretical physics. Yet, this is precisely what these TCM naysayers are doing. Which one of you have any true understanding of TCM to qualify you to attack TCM?

(And FYI, to become a qualified TCM practitioner in China, for example, you need to study in a TCM university for 5 years and then have a number of years of residency before you can even apply for a doctor’s license.)

Hey, gvh.

You posted exactly the same thing on the other thread.

You received several substantive replies pointing out the flaws in your logic.

If you were intellectually honest, or any kind of honest, you could have at least tried to answer the objections offered.

Instead, you just posted the exact same bullsh!t verbatim.

I find that so rude I'm going to answer with equal rudeness. FOADIAF. Sever your connection to the Internet and increase its collective intelligence. Somewhere in the aisles at the local toy store there is a character doll that, when you press a button on its back, recites a series of banal catchphrases from a TV show aimed at children who think fart jokes are the height of humor. Which has more moral integrity, you or that doll? The answer is: the doll, because it is only trying to entertain children - not engaged in a deliberate, dishonest attempt to counterfeit the appearance of adult behavior while subverting it in the most disgusting fashion. If you had the moral integrity of a puke stain, it would be a step up.

AdamG: "scientific method = it doesn’t exist unless you can prove it." What herr doktor bimler replied was exactly what I was referring. People blindly believed earth was flat at that time, until Columbus proved them wrong by action. But we didn't see it happening, how can we prove the history is not fictitious? According to AdamG's scientific method, this part of history didn't exist. We also can't see A's brain, we can't touch it, feel it, measure it, look at it carefully before we cut his head open, thus A's brain doesn't exist.

This quote "If you want to judge something, learn it thoroughly first." is not from Feynman whom I have never met and can't prove he existed. It's from Adam or Alex something. Sorry, I am not a good student and bad in remembering names.

I spent a few years trying to learn how Chinese medicine works after TCM and acupuncture cured my "treatable and controllable only" problems, e.g. asthma and atopic dermatitis. According to my understanding. There are several different Qi's. Some might be energy, some are not. The Qi's categorized as Jing Luo Qi is the effect of how different glands interact with each other, it's not energy at all. This part if Qi's can be 100% mapped to modern endocrinology and explained more things than the textbook I have. I drew my findings about mapping Shen Jing Qi to the endocrines all the way from kidney to thyroid on a paper, but it's missing after my partner cleaned up the desk. I will probably drew it again and map other Jing Luo Qi's when I have long holidays. Because this paper doesn't exit any more, according do AdamG's scientific method, I didn't do any research. My skin is not as white as the paper on my desk, thus I am black?

AdamG, P+Sp->Q . Where is Sp in this scientific method religion?

Sorry about the stupid typos. I was typing on my phone during my lunch break.

Jerry - learn to read.
What HDB said is the exact opposite of what you think - he was making fun of your naive acceptance of the Columbus myth and inability to write clearly.

Why is it a myth? Because Columbus was wrong. Pretty much everyone knew the earth was round, and had since the Greeks. The reason they objected to Columbus' expedition was because they knew he had done his calculations wrong and was going to run out of supplies before he reached China. And they were right! If it weren't for the coincidence of America being there, Columbus' expedition would have been a deadly failure by someone who didn't listen to the people who knew what they were talking about,

It wasn't going there that demonstrated the earth's roundness - the Greeks worked it out easily while staying at home. This is how proof works - you notice strange things, make predictions and test them. The roundness of the earth is testable without seeing it, because it has effects on things like lines of sight and shadows. The presence of A's brain is testable without seeing or measuring it because it allows A to walk and talk.

According to your own test, you should not be judging either history or science.

Jerry@65:

People blindly believed earth was flat at that time, until Columbus proved them wrong by action.

Which people, exactly? The ancient Greeks knew the Earth was spherical. The early Islamic world worked out a remarkably close estimate of its diameter.

Just because you believe your little anecdote with all your heart does not actually make it true. I believe there's a larger lesson in that—like Wally, let's see if you're capable of finding it.

>This quote “If you want to judge something, learn it thoroughly first.” is not from Feynman whom I have never met and can’t prove he existed. It’s from Adam or Alex something.

I am grateful for this example of how to learn things thoroughly before judging.

To Antaeus Feldspar,

I got the 2 posts by ORA mixed up and thought my comment did not post. Please see his/her other post for my response. BTW, if all you can do is name calling, this is truly a pathetic place. And angry people and narrow-minded people, per TCM, are prone to the following (in order of likelihood): liver and eye problems (including myopia; no pun intended!!), digestive issues, neck, shoulder and back problems, heart issues (including high-blood pressure), migraines, and skin problems (including slow-healing skin injuries). Now I'm really curious if you have any of the above.

No offense to the stupid, but how can you make GVP truly understand logic, induction, probability and rationality in general?

to become a qualified TCM practitioner in China, for example, you need to study in a TCM university for 5 years

And to become a Doctor of Divinity in 13th-century France, for example, you need to study the Trivium for two years at the University of Paris and then advanced study of the Quadrivium for three years.* Therefore angels are real.

* I can't be arsed looking up the actual curriculum for 1250 because GVH hasn't earned more than 20 seconds response.

@ gvh

if all you can do is name calling,

Name-calling due to a mistake you did. Everybody should be sorry and making apologies, not pouring oil on the fire.

Also, there is nothing wrong with being angry at cheaters and con-men. It's called having some sense of honesty.

And angry people and narrow-minded people, per TCM, are prone to the following (in order of likelihood): liver and eye problems (including myopia; no pun intended!!), digestive issues, neck, shoulder and back problems, heart issues (including high-blood pressure), migraines, and skin problems (including slow-healing skin injuries)

About 90%+ of humanity.suffers at one point of their life of one or more of those.
I am afraid the correlation doesn't pan out.

Note to the lurkers: this is a typical well effect (as in "falling into the well"), most commonly used in writing horoscopes and other false-prophet systems.
Just utter a few things, seemingly very precise ("you usually are a calm and measured person but occasionally you get angry and lash out", "you usually watch your budget but sometimes you buy yourself some treats") but actually fuzzy enough for a lot of everybody to recognize themselves in the description.
It's a pre-internet form of phishing, really.

Please see his/her other post for my response.

Imagine my surprise to look at the other thread containing GVH's braindropping and find no response.

@gvh - So please enlighten us. What is the evidence that TCM as a system provides a useful theoretical framework that is well backed by evidence? Does it provide better clinical results than conventional medicine (as practiced in, say, the United States) and if so, how do you know that?

Thanks.

Wow! So at age 4 I was ...angry people and narrow-minded people...myopia; ? Who knew a 4 year old could be like that? Also, my cousin, from birth (he got glasses at about 9 months of age). I'm so impressed that TCM knew all that about us! We should have used cures from TCM instead of seeing the eye doctor.

Oops...deleted a little too much. Should have been :"angry people and narrow-minded people, per TCM, eye problems (including myopia"

Deb, thank you for pointing out the Columbus myth. I was taught to believe it in school. I didn't question what was in my history textbook back then because I blindly believed whatever teachers taught me must be true, whatever different must be wrong. I also had this kind of "black or white" mind. Because of my profession is not related to history, I didn't spend time to update the my history knowledge. I only questioned what medical school taught us so far. I started questioning my education since I suddenly noticed all new drugs in our "evidence based" medicine world only focus on hiding the symptoms instead of doing anything about the real cause of the illnesses, and the patients need to come back for prescriptions until they die. We were indeed taught to find the cause of the problems, but usually only found it half way, the real cause is usually one or two steps further than who we taught to believe.

Btw, does it mean the history about people believed the earth was flat and sun revolved around earth, and killed people who said earth is round and earth goes around sun is actually a myth?

It's true that I am bad in understanding puns and sarcasms in general, as I always say things as what it really is instead if playing word games which I personally feel it's ambiguous and time wasting. It's worse when I only have time to read and type here during my short breaks. I will try to learn some humor to make me type more like a human.

My point of my replies are:
1. Don't judge a book by its cover. I believe most of you didn't even have a chance to see a TCM book's cover. You can go to Amazon and see one now lol. That's what the quote I used about.
2. If you make your preexisting knowledge becomes prejudice to judge another approach which you don't really understand and and refuse to learn anything about it. You are confined in your own world and will miss out the chances to broaden your horizon. If I kept my medical knowledge to judge TCM and other medical systems, I would be still coughing and have itchy skin everyday because our "science based medical industry" only have medicine to inhibit my symptoms instead of fixing the real problems. My partner would have already done her heart surgery and needs to get her heart checked every year.
3. If you judge TCM and eliminate it now, you may also eliminate some treasures which we don't understand how they work yet.
4. From my experience and understanding, TCM is more evidence based than our evidence based medicine. They just use different approaches and words to see the same things. Remember we have 2 approaches to do differentiation?

"I only questioned what medical school taught us so far...."

Here is a test of how well you did to get into medical school, which I assume included some actual science classes like physics: what is the difference between kinetic and potential energy and how are they related?

By the way, I learned the Greeks measured the circumference of this planet in my elementary school in Ft. Ord, CA in the 1960s.

@gvh you are right and wrong at the same time. Angry people indeed usually have more catecholamines, adrenalin, and T3 in there blood, and the chain effects can cause the symptoms as what you mentioned in your post. The reason->result description is correct in both science based and TCM theories.

you asked Antaeus Feldspar to check the symptoms in your reply. This part is not right, as this is the process of using the result to determine the reason. It's logically incorrect. The symptoms can also be caused by other reasons, the result->reason process is not a one way street. As I know, TCM doctors need to see the patient, check the patient's tongue, pulse, smell, other things like urine and excrement etc. before saying anything about the diagnosis. Some of them even use modern technologies like MRI and meridian meter (I have one at home as a toy. It's funny that every time when I connect it to my computer and my computer tells me that I have caught a cold, it's always right. But my TCM doctor friend says it's a rubbish). This is where you are not doing right according to the TCM diagnosis procedure and making an overgeneralized comment.

Chris, what's the point of testing me the basic classical physics question? Is it related to this topic or you are just making it personal?

The point is to evaluate your understanding of "energy." Something that you should expect when you quote a quantum physicist with the words "If you want to judge something, learn it thoroughly first.."

If you want to criticize the the string theory as hogwash, you must first have a Ph.D-level in-depth understanding of theoretical physics

This is not a prerequisite to noticing that unless something shows up at 14 TeV, it's not going to be able to make any testable predictions about the real world any time in the foreseeable future, for a very specific reason.

Of course, what's actually considered to be "hogwash" is the hype machine, which has now devolved into Multiverse mumbling precisely because of this. Like Elvis fans, 10⁵⁰⁰ string vacua can't be wrong. But at least this disaster still lives in the material world.

By contrast, TCM is in a vastly worse position, given that it has the entire enterprise exactly backward. Disease is defined as an imbalance of yin and yang, and the elaboration is all downhill from there. Shen controls mental functioning but resides in the heart. Sound familiar? A symptom of spleen qi deficiency is diarrhea. Is this a characteristic chronic sequela of splenectomy? How does yuan qi get sorted into ying qi and wei qi in this situation? There's a trivial, definitive test for prodromal measles; how does it compare with a tongue examination and pulse "classification"?

Chris, you asked the same question earlier because you originally thought I agree with Qi was energy. I made it clear that the Qi's I can understand are the effects of our endocrine system and they are not energy.

Now you are asking it again just because of I quoted what a quantum physics professor said in a class. Don't you think you should test me some quantum physics questions instead? No matter what my answer is, they have nothing to do with TCM. Even a janitor who was standing outside of the classroom and heard this quote can get inspired by him without understanding anything about quantum physics. The point is DON'T MAKE YOUR KNOWLEDGE BECOME YOUR PREJUDICE.m
M
If I said the other group of qi's which are not related to endocrine ae actually some dark energy. Would you test my understanding of dark energy or classical physics? Lol

Admit it, you are just making it personal and trying to find faults. If I can't say everything 100% right, then you are going to make a conclusion that 100% of what I said was wrong. If you can't answer 2 out of 10 questions correctly in a exam, does it mean you don't understand the other 8 questions which you answered correctly? When science based medicine was wrong somewhere, we just simply changed whatever was wrong based on the new findings, it's happening every year, and we will keep doing it in the future. we don't say the whole system is a rubbish because someone made some mistakes and we were following the same mistake, right? We are judging TCM based on our prejudice and wrong translations. There are things in TCM don't look right based on our knowledge in our own system, without considering it's a completely different system, different approaches, different philosophy behind, different language, different tools. How fair the judgements can be?
I only deciphered a small part of qi's which are related to endocrine system and found this part of TCM is treasure. Can I say the whole TCM is a treasure island? NO! Can I say the other part of TCM is rubbish especially those shen qi, yi qi, zhi qi blah which seems to be more related to psychology at the second glance? Still NO!

So you can't answer a high school physics question, this kind of points to your general knowledge about science. It is something most people who are accepted into medical school would know (it is fairly important in biomechanical and biochemical systems). You don't, so now we know the level of your veracity.

I made it clear that the Qi’s I can understand are the effects of our endocrine system and they are not energy.

Because you drew a picture?

The Qi’s categorized as Jing Luo Qi is the effect of how different glands interact with each other, it’s not energy at all. This part if Qi’s can be 100% mapped to modern endocrinology and explained more things than the textbook I have. I drew my findings about mapping Shen Jing Qi [sic] to the endocrines all the way from kidney to thyroid on a paper, but it’s missing after my partner cleaned up the desk.

This does not inspire great confidence in your understanding of endocrinology.

Chris, Can't you see that I was refusing to fall in your pointless trap? and you made the exact comment which I predicted what you are thinking about. lol
Not everyone are that eager to seek validation from strangers.

Narad, I dew a picture to help me to understand it. What inspired the confidence was the interaction of the glands and the chain effects which I never thought about before.

As to "how does yuan qi get sorted into ying qi" in your reply. I discussed with 2 TCM doctors about it 2 years ago, and I can briefly explain it in the words we all can understand. The whole sentence is actually wrong. It should be when Yang Qi get stored in Kidney Yin (just Yin, no Qi), the Yang Qi will be called Yuan Qi.
First we need to understand Yin and Yang are also categories in Chinese dualism system which is highly integrated with a 3 bits and 6 bits binary math system called Zhou Yi. Chinese categorized everything in pairs and chuck them in the Yin and Yang buckets, e.g they chuck things are hot, bright, noisy, fast to Yang bucket, and cold, dark, quiet, slow to Yin bucket. It's very similar to the concept of "der" and "die" in German. In this binary system Yang=1 and Yin=0.
When talking about Yin and Yang in human body, Yin means the physical body which you can see, touch, cut, and perform surgery on. Yang means the functions of our organs. Kidney Yin simply means the physical kidney, in the binary system Kidney Yin=101. Yang Qi=010 which actually means the functions, e.g. our heart beats, body temperature, bowel movements...etc. Yuan Qi=101::010=111 which means the functions related to kidney meridian. Storing Yang Qi to Kidney Yin=our lung gets oxygen, digestion system extracts nutrition, heart pumps blood to kidney, and then becomes Yuan Qi, yeah...kidney functions. It's not the end of story yet.
In the Zhou Yi system, 111 is a special state, because 010(Yang Qi) can easily separate from it's reservoir, and then all glands related to kidney meridian in TCM system can release the related endocrines back to our lung, heart, muscles, sotmach..etc.
After deciphering the whole esoteric sentence "Yin, Yuan Qi....blah" is actually a common sense which even our children all have learned about it in plain English, isn't it?

This is actually not even half of the story, but I can only remember that much. One of my TCM doctor friends in the discussion 2 years ago explained a lot about how our organs interact with each other by using the binary system calculation. However the other TCM doctor (mediocre one) knows nothing about it. Don't ask me about how the binary system works. I didn't learn it.
According to the TCM doctor who explained it in plain English to me, more than 90% of TCM doctors don't know anything about it because it's not taught in university, thus It's true that most TCM doctors don't even know what Yin and Yang really are.

First we need to understand Yin and Yang are also categories in Chinese dualism system which is highly integrated with a 3 bits and 6 bits binary math system called Zhou Yi. Chinese categorized everything in pairs and chuck them in the Yin and Yang buckets, e.g they chuck things are hot, bright, noisy, fast to Yang bucket, and cold, dark, quiet, slow to Yin bucket. It’s very similar to the concept of “der” and “die” in German. In this binary system Yang=1 and Yin=0.

I'm aware of what Yin and Yang are, in terms of their philosophical, so to speak, definition, but I don't find the concept to be particularly useful in terms of describing the world. It's a projection of random qualities loosely associated with human gender roles onto inanimate objects, concepts, etc.

It's not even really related to the "concept" of "der and die" (you forgot "das") in German. Grammatical gender, when it comes to inanimate nouns, doesn't really have anything to do with properties of the objects themselves; it's a function of words and sounds and so on. The assignation, at least in Indo-European languages, is really quite random; in German, the moon is masculine and the sun is feminine. In Russian, the moon is feminine and the sun is neuter. In German death is masculine, in Russian it's feminine. And so on.

Given that the whole yin/yang concept is so much bunkum to begin with, I don't see how overlaying it with some sort of bizarre mathematical construct is going to result in something that makes any more sense.

*I can't find the exact quote, and I really ought to be asleep, but I remember reading a few lines of Suzuki Roshi's - I think it was in Zen Mind, Beginner's Mind - where he mentions the notion of masculine and feminine energies in the universe or whatever, passivity is feminine and activity is masculine and yadda yadda, and says in so many words, "This is nonsense. Men and women have an anatomical difference. That is all."

However the other TCM doctor (mediocre one) knows nothing about it. Don’t ask me about how the binary system works. I didn’t learn it.
According to the TCM doctor who explained it in plain English to me, more than 90% of TCM doctors don’t know anything about it because it’s not taught in university, thus It’s true that most TCM doctors don’t even know what Yin and Yang really are.

I was looking forward to making fun of Jerry's octal-system magical-thinking numerology... but if the vast majority of TCM practitioners do not endorse this intellectual framework, then despite its entertainment value it's not TCM, and deserves a name of its own.

" it's true that most TCM doctors don't even know what yin and yang really are".

I can agree with that.

Jerry is just blowing smoke. Move along, literally nothing to see here.

herr doktor bimler, I don't have too much time to explain the old Chinese education culture and not an expert about it. Make it short, some TCM knowledge is still kept as their "lineage master and student" secrets. Yes, it's the same as the Chinese kong fu movies cliche! They don't share the most essential knowledge outside of the lineage including the students which the master doesn't like, that's why their modern universities don't have any knowledge about the "secrets" which is not so secret, just like the example in my previous reply. But it's the key knowledge to make a mediocre doctor becomes a good doctor.
Why don't they share the knowledge? 1. Selfish! They have been using this selfish lineage system for centuries to make only some of them can earn more money. 2. Lazy and stupid students can't understand it, so why bother. 3. Some of them made the vow that they can't spread the knowledge.

The TCM doctor told me about this actually is not the only one breaking the rules and spreading the "secrets" for free. He didn't tell me the reason, but the reason is obviously. Selfish again! The majority of the mediocre TCM doctors are giving TCM a bad name, and he knows TCM will die in these people's hands eventually. If the TCM doctors who knows the "secrets" don't release the "secrets" to the mediocre doctors and even western doctors, they won't be able to make any money as soon as TCM dies. One of the secrets is actually how to translate the esoteric nonsense "yin yang" words back to what it really means in plain language as I mentioned.

JP is right, these yin yang philosophy is nonsense, at least our interpretation of it is nonsense; it's the same as the world can't be generalize to only black and white (a lot of ignorant people is still doing it, especially some of us here lol). Does TCM really based on this philosophy because the lineage masters used the nonsense words to describe things? or they had limited vocabularies back in hundreds (or thousands?) years ago, or maybe they just wanted to encrypt the textbooks to prevent knowledge leakage? I don't think anybody knows.

herr doktor bimler, I really wish that "Jerry’s octal-system magical-thinking numerology" was mine. Unfortunately, I didn't create it and can't sell it, and don't even understand it.
The TCM doctors showed me things in human body which I already know and didn't know by that "numerology". He was all correct. Is it coincidence or there is really something in it, or it's a stage magic he invented to make fun of western doctors? I can only say I couldn't find anything wrong, and didn't record a video to do further research to verify it.
There's one thing probably I should've mentioned. He said the math system helped him understand human body, but people still can be a good TCM doctor without learning it, they just need to memorize more stuff to achieve the same level. herr doktor bimler, do you still think it deserves it's own band name?

I am not defending for TCM. I probably could make a few more dollars if TCM didn't exist and patients didn't have any alternative choice. Really, I just don't want to see our culture becomes so closed minded and judge a book by its cover, judge a completely different system based on our prejudice. This arrogant attitude is already giving us bad names.

Chris, if you withdraw your emotions and prejudice, step back and read what you wrote in a fact based mind, you will notice that you really have a "yin yang philosophy" mind. Unfortunately, most people needs training to achieve it, thus you won't be able to see it.

I am sorry about that, labeling is also notorious in our culture. It's causing issues in our society, and sending more people to psychiatric wards. Don't expect too much, I am just an average people, mate.

In this binary system Yang=1 and Yin=0.

The I Ching coin oracle is going to be quite surprised.

Is there a TCM remedy for Iching? Asking for a friend.

Narad, I dew a picture to help me to understand it. What inspired the confidence was the interaction of the glands and the chain effects which I never thought about before.

Uh-huh. Are you going to get around to that splenectomy question?

Jerry: "Chris, if you withdraw your emotions and prejudice,.."

I gave you a simple high school level test, and you failed. What emotion? The laughter at you trying to sound all smart like? How is it "prejudice" to point out that you do not have a clue? You are just hilarious.

So, Jerry, it sounds like you, I, Chris, and Herr Doktor Bimler are agreed that what is generally presented as "traditional Chinese medicine" is a farrago of nonsense. The difference is that you think that some people in China are doing something else with the same name, using the words to mean unrelated things, that actually works, only they're keeping most of it secret.

I suppose that's possible: but even if it's true, it doesn't count as an argument for TCM. Nor does it make me think highly of those people, who would rather leave most of the human race in ignorant misery than share their knowledge--but who at the same time expect us to *respect* them for their hidden knowledge, rather than scorning and condemning them for hiding information that, if they are correct, could save lives.

The difference is that you think that some people in China are doing something else with the same name, using the words to mean unrelated things, that actually works, only they’re keeping most of it secret.

One might be reminded of the Usui Reiki Ryoho Gakkai.

Nor does it make me think highly of those people, who would rather leave most of the human race in ignorant misery than share their knowledge–but who at the same time expect us to *respect* them for their hidden knowledge, rather than scorning and condemning them for hiding information that, if they are correct, could save lives.

In honest parts of the culture, Chinese and Western alike, that sort of information hiding is considered a hallmark of quackery. I call your attention to Stan Burzynski's behavior.

Did I miss the post where our initial commenter Michael the nuclear engineer who made some astounding statements therein, came back with an extensive lists of sources for his claims???

The 2015 Nobel Prize in Physiology or Medicine for the discoverer of Artemisinin: A triumph of natural product pharmacology, not traditional Chinese medicine

oracknows — Wed, 07 Oct 2015 07:30:07 +0000

The 2015 Nobel Prize in Physiology or Medicine for the discoverer of Artemisinin: A triumph of natural product pharmacology, not traditional Chinese medicine

Earlier this week, the Nobel Prize in Physiology or Medicine was awarded to Youyou Tu for her discovery of the anti-malaria compound Artemisinin, as well as to William C. Campbell and Satoshi Ōmura for their discovery of a novel therapy for roundworm. Artemisinin, as some of you might know, is a compound derived from traditional Chinese medicine, which is why, to my irritation, it didn't take long for headlines like How traditional Chinese medicine finally won its Nobel Prize, What the 2015 Nobel Prizes mean for traditional Chinese medicine, and A Medical Breakthrough Made Possible By Ancient Chinese Remedies Just Won A Nobel Prize. In each of these there is, to a varying degree, an underlying implication (in one case not even an implication) that somehow the awarding of the Nobel Prize this year to Tu is a vindication of not just Artemisinin, but of the entire system of traditional Chinese medicine. I will argue that it is nothing of the sort, but rather a vindication of the modern science of pharmacology, specifically pharmacognosy, the branch of pharmacology that concerns itself with finding medicines in natural products.

In one glaring example of the crowing of how this Nobel Prize somehow "vindicates" TCM and shows how it is becoming accepted by "Western" scientists, Sam P.K. Collins writes at ThinkProgress about how "Western" doctors "didn't catch on" to Artemisinin until the 1980s (Youyou Tu had worked on it in the late 1960s and 1970s) and the World Health Organization didn't recommend it for malaria until 24 years later, going on to claim:

Despite its more than 4,000-year history, detractors say traditional Chinese medicine stems from a superstition-based culture that predates modern medicine. They also say the medicine’s reliance on anecdotal evidence goes against what the reliability of scientifically controlled experiments that have proven the efficacy of conventional medicines and therapies.

However, Chinese medical practitioners have pushed back against that view, arguing that opening up to traditional medicine could help advance conventional treatments — especially as developments of new medications are hampered by a lengthy research process and growing drug resistance has rendered some drugs useless.

Note the argument from antiquity, the implication that, because TCM has been around thousands of years, there must be something to it. There is a false dichotomy there, as well. TCM is indeed based on prescientific views of how the human body works and how diseases develop that is very much like the idea of the four humors in what I like to call "traditional European medicine" promulgated by Hippocrates and his followers. After all, in TCM there are the "five elements" thought to be associated with disorders of various organs and the activity of what are known as the Six Pernicious Influences: Heat, Cold, Wind, Dampness, Dryness and Summer Heat. These are thought to cause "imbalance" in the body and thus disease. Indeed, the very basis of TCM is far more philosophical than scientific, the idea being to restore "balance" to the body, perhaps in much the way that the Chosen One would restore balance to the Force, often with much the same effect.

To Collins, the awarding of the Nobel Prize to Tu is both a vindication of TCM and an indication that the tide is turning in terms of acceptance of TCM by "Western" science. Citing a keynote address by Dr. George Y.C. Wong at a TCM conference in 2012 (an address full of tropes about TCM, so much so that it might be worht addressing in a separate blog post) about how, "unlike Western medicine, ancient Chinese treatments take into account patients’ individual characteristics and the connection between the body and mind," Collins declares:

Three years later, that’s becoming more of a possibility. As more Americans grow distrustful of doctors, traditional Chinese medicine and other non-Western practices have grown in appeal. One survey conducted earlier this year showed that young cancer patients eager to ease the symptoms and side effects of chemotherapy have turned to traditional treatment. In response, hospitals across the country have started to integrate their health care with Eastern-based treatments and therapies — including acupuncture, massage therapy, and herbal medicine. And some medical schools now include these practices in their curricula, creating a field known as “complementary medicine,” which allows doctors to infuse conventional and alternative medical practices to their patients’ liking.

Globally, the medical community may be changing its tune. Tu counted among three recipients of the Nobel Prize in medicine, all of whom used natural-based remedies against parasites. William Campbell, an Irish-born researcher who lives in New Jersey, and Satoshi Omura, who is from Japan, both won for their discovery of avermectin, which was developed into ivermectin, a treatment for river blindness. These drugs have replaced their quinine-based counterparts which have proven ineffective in years past.

This is, of course, an old tune, one we've been hearing for a long time, how TCM is really valid, how it is being proven scientifically and embraced by the masses outside of China. Of course, forgotten in such descriptions is how, in China itself, TCM is increasingly being abandoned for scientific medicine and how TCM as we now know it is actually a creation of Mao Zedong, who, lacking sufficient resources after World War II and into the 1950s and 1960s to provide "Western"-style scientific medicine to all of his people, enlisted "barefoot doctors" practicing TCM and advocated the "integration" of TCM with "Western medicine" in a prescient foreshadowing of how alternative medicine evolved into "complementary and alternative medicine" (CAM) and then into "integrative medicine." Mao himself did not use TCM and did not believe it worked, finding the Five Element concept implausible and stating bluntly, "Even though I believe we should promote Chinese medicine, I personally do not believe in it. I don’t take Chinese medicine.”

My citing this history should in no way be viewed as viewed as an attempt to denigrate Tu's accomplishment. Rather, I point it out because there is a long history of TCM advocates latching on to one discovery that appears to show that there is medical value in something in TCM and trying to argue that it means that we should take seriously the rest of the prescientific edifice of TCM, the pseudoscientific baggage that comes along with the occasional pearl. Indeed, this sort of argument was on full display earlier this year when Science shamefully published a multi-part supplement that was basically an advertisement for TCM research. In fact, Tu deserves all the honors she has received over the last few years, first with the Lasker Award in 2011 and now with the Nobel Prize in 2015.

While the concepts behind TCM are prescientific and superstition-ridden, the one area of TCM, as is the case with other kinds of folk medicine, is the natural products used by folk medicine healers to treat various conditions. Indeed, in the case of TCM and other traditions, such as Ayurveda, I tend to like to separate the herbal medicine component from everything else, because it is there, regardless of the philosophy that spawned the treatments, that actual useful medicines might be found. The tools that find such medicines includes pharmacognosy, and that's what happened here. A little history is in order.

In the US and most developed countries, malaria is not much of a problem because the mosquitos that carry it thrive in tropical and subtropical climates, such as Sub-Saharan Africa, Asia, and Latin America. There the disease is associated with poverty and reaps a horrible toll every year. Indeed, the WHO estimates that there were close to 200 million cases of malaria worldwide in 2013, resultin in 584,000 to 855,000 deaths, the vast majority in Africa. Because the disease affects those living in tropical regions so heavily, it is often forgotten in developed nations just how many people suffer and die every year from the disease.

In the 1950s, attempts to eradicate malaria failed because of the emergence of a chloroquine-resistant strains of Plasmodium falciparum, the parasite that causes malaria. At the time chloroquine was the main drug used to treat malaria, and this resistance led to a resurgence of malaria in tropical regions, including North Vietnam and parts of China. There was a vital need for new anti-malarials, which led the Chinese government in 1967 to set up a national project against malaria under the leadership of what was called Project 523. Youyou Tu herself told the tale in a fascinating article published in Nature Medicine in 2011 after she had won the Lasker Prize. Tu had the necessary qualifications to head this project, having graduated from the Beijing Medical University School of Pharmacy in 1955 and been involved in the research of Chinese hebal medicine in the China Academy of Chinese Medical Sciences (previously known as the Academy of Traditional Chinese Medicine). From 1959 to 1962, she had participated in a training course in Chinese medicine especially designed for professionals with backgrounds in "Western" medicine, which led her to see the potential in TCM herbal remedies.

She described the process thusly:

During the first stage of our work, we investigated more than 2,000 Chinese herb preparations and identified 640 hits that had possible antimalarial activities. More than 380 extracts obtained from ~200 Chinese herbs were evaluated against a mouse model of malaria. However, progress was not smooth, and no significant results emerged easily.

The turning point came when an Artemisia annua L. extract showed a promising degree of inhibition against parasite growth. However, this observation was not reproducible in subsequent experiments and appeared to be contradictory to what was recorded in the literature.

One notes that, to identify these 2,000 TCM herbal preparations, Tu scoured TCM texts. Here's where the insight from a TCM text came in:

Seeking an explanation, we carried out an intensive review of the literature. The only reference relevant to use of qinghao (the Chinese name of Artemisia annua L.) for alleviating malaria symptoms appeared in Ge Hong's A Handbook of Prescriptions for Emergencies: “A handful of qinghao immersed with 2 liters of water, wring out the juice and drink it all” (Fig. 1). This sentence gave me the idea that the heating involved in the conventional extraction step we had used might have destroyed the active components, and that extraction at a lower temperature might be necessary to preserve antimalarial activity. Indeed, we obtained much better activity after switching to a lower-temperature procedure.

When I read this passage, I note two things. First, qinghao was not used in TCM to treat malaria, only to lower fever; indeed, its whole plant extract does not result in a sufficiently high concentration of the active ingredient to treat malaria. Basically, Youyou Tu and her team scoured TCM texts to identify anything used to treat fever. Second, I wasn't exactly sure how that particular passage led to the insight that heating the extract was degrading the active component of Artemisinin. After all, all that was in that text was a lack of a mention of heating the extract, and noticing an absence of a step is a different thing than noting the presence of a step in preparing an extract, after all. When I see a recollection like this, I tend to suspect that the person relating the memory was already thinking along those lines anyway and that the text jarred something in Tu's brain to cause the proverbial lightbulb to go off. There's nothing wrong with that, but she could just as easily have been wrong about this. Fortunately, she was not. This new method of preparation led to Tu's being able to separate the extract into its acidic and neutral portions. On October 4, 1971, Tu isolated a nontoxic neutral extract that was 100% effective against parasitemia in mice infected with Plasmodium berghei and in monkeys infected with Plasmodium cynomolgi. Next, because it was during the Cultural Revolution and there were "no practical ways to perform clinical trials of new drugs," Tu and her colleagues volunteered to be the first to take the extract. After determining that it was safe for human consumption, they began testing it in patients infected with both Plasmodium vivax and P. falciparum. The results were encouraging. In patients treated with the extract, fever rapidly declined, as did the number of parasites detected in the blood, which did not happen in patients receiving chloroquine.

But Tu was still not done, and this is the message frequently forgotten by advocates who latch on to this Nobel Prize as a vindication of TCM. Pharmacognosy led to the discovery of Artemisinin, but it took medicinal chemistry to turn this compound into a usable, useful drug. Sources rich in the molecule had to be identified, methods of isolating it on a large scale developed, and a stable formulation produced. As Tu put it, her team now had to go from molecule to drug:

In keeping with Goldstein's view, the discovery of artemisinin was the first step in our advancement—the revelation. We then went on to experience the second step—creation—by turning the natural molecule into a drug.

We had found that, in the genus Artemisia, only the species A. annua and its fresh leaves in the alabastrum stage contain abundant artemisinin. My team, however, used an Artemisia local to Beijing that contained relatively small amounts of the compound. For pharmaceutical production, we urgently required an Artemisia rich in artemisinin. The collaborators in the nationwide Project 523 found an A. annua L. native to the Sichuan province that met this requirement.

The first formulation we tested in patients was tablets, which yielded unsatisfactory results. We found out in subsequent work that this was due to the poor disintegration of an inappropriately formulated tablet produced in an old compressing machine. We shifted to a new preparation—a capsule of pure artemisinin—that had satisfactory clinical efficacy. The road leading toward the creation of a new antimalarial drug opened again.

As Kausik Datta notes, Tu was also using medicinal chemistry to modify Artemisinin to improve it:

In the true tradition of proficient medicinal chemists, Tu wasn't satisfied with existing qinghaosu [the Chinese name for Artemisinin]; as early as in 1973, she had already chemically modified Artemisinin to dihydroartemisinin. Overcoming the initial concerns about its chemical stability, she found that this substance was stable, possessed ten-fold higher anti-malarial potential than Artemisinin, reduced the risk of recurrence, and provided the opportunity to develop newer Artemisinin derivatives through chemical modifications.

Several of the articles touting Tu's Nobel Prize implied that the reason Artemisinin wasn't accepted right away in the "West" was prejudice against TCM. It turns out that Tu's results were not published internationally until 1979. As Tu put it in her Nature Medicine article, the chemical structure of Artemisinin was determined in 1975 and published in 1977, but "the prevailing environment in China at the time restrained the publication of any papers concerning qinghaosu, with the exception of several published in Chinese." After publication in 1979, Tu presented her group's work in 1981 at the Scientific Working Group on the Chemotherapy of Malaria in Beijing, sponsored by the United Nations Development Programme, the World Bank and the World Health Organization (WHO). She noted that the "efficacy of artemisinin and its derivatives in treating several thousand patients infected with malaria in China attracted worldwide attention in the 1980s"²¹.

Indeed, WHO representatives at the conference were very impressed with what they heard. They immediately approached the Chinese government for samples of the plant and details of the extraction process, so that they could replicate the findings reported. This is, of course, what scientists do when they hear of a highly promising new treatment like this. However, at the time, the Chinese government was reluctant to share these details, and, as Maude et al put it in a description of the history of Artemisinin, "further collaboration did not occur at that time." It's likely that Cold War politics and the insular nature of the Chinese government was a bigger factor in the delay in acceptance of Tu's findings by the rest of the world than distrust of the source of the drug. After all, scientists have been screening various natural products and extracts for pharmacological activity against diseases such as cancer for many decades, and many of our most useful drugs were derived or modified from natural compounds.

Tu's accomplishment is remarkable and definitely deserving of the Nobel Prize, as it is a triumph or modern pharmacognosy and medicinal chemistry. Unfortunately, even the Nobel press release about Tu's award seems to imply that this discovery was due to TCM. Yes, there may well be more pearls like Artemisinin in the thousands of herbal remedies used in TCM, but they will only be identified and validated by rigorous science of the sort applied by Tu nearly five decades ago. What is also forgotten is what a small proportion of these compounds will actually pass this test of rigorous science. Remember, Tu screened over 2,000 compounds, only a third of which showed any promise and only one of which became a useful drug. TCM herbalists tend to forget this and skip the steps that Tu went through over several years of hard work. They also tend to forget that the validation as a safe and effective medicine of an active compound derived from a TCM herbal preparation does not validate the mystical ideas that underlie TCM and are the basis for all of its non-herbal practices. Science works. Mysticism does not.

oracknows Wed, 10/07/2015 - 03:30

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Medicine

The article I saw on this made it very clear that the Nobel was for the isolation and synthesis of the active drug, not for the TCM influence.

I have no problem with the idea that various cultures have empirically discovered certain plants that are pharmacologically active. Better of course to isolate and synthesize the active ingredients, for the sake of purity and control of dosage.

Hopefully the mainstream media will get the story right, but we can expect the usual crowd of charlatans to spin it to suit themselves. Only question is which charlatan will be first-to-market with a "supplement" based on this. I'll bet it's Mike Adams. That's a safe bet.

I was hoping you'd write about this. Every TV news article I've seen had the same opening - Western medicine finally accepts a tradition Chinese drug, or something very similar. And every time I heard it, I thought, "Orac will write about this, and use actual facts." Thank you.

I'm more than a little surprised that anyone with any knowledge of biochem wouldn't have considered the consequences of using only hot extraction methods, right at the very beginning. Perhaps there was a little too much adherence to traditional methods, rather than long-established scientific methods.

Looks like artemisinin is already be sold in mass production as a:

"NutriCology® Artemisinin is an easy-to-take hypoallergenic dietary supplement delivering 200 mg of Artemisinin per serving. Chinese herbalists have used this herbal supplement for some 2,000 years to support immune health. It is a wonderful, go-to immune tonic found in many herbalists' supply." (sold by a vitamin company online, of course)

Meanwhile, the WHO is worried about resistance developing by P. falciparum to artemisinin.

Gee...thanks TCM quacks for helping to ruin a good thing.

The key point is one you have made before: Science-based medicine is glad to accept any treatment proposed by alt-med types, whether TCM or otherwise, that holds up under rigorous testing. Here, we have an example of something that passed the test. It is notable because such successes are so rare.

Also worth noting is that, when Dr. Tu was doing her initial work, she didn't publish in English, as she automatically would have done if she were doing similar work today. Many Ph.D. programs used to have foreign language requirements because a large fraction of the literature was in languages other than English. Sometimes, as in Dr. Tu's case and for many scientists in the USSR, this was for political reasons. There are historical reasons: leading-edge research as recently as the 1930s would more often be published in German than in English. Many non-scientists, and more than a few scientists, forget this history. At least German and Russian are Indo-European languages with alphabets, so they aren't as difficult for Westerners to learn as Chinese.

For those who have seen articles that praise the supposed TCM aspect:
Did any of them mention quinine - something that might be regarded as western traditional medicine?

Many news sources also neglected to mention the heavy contribution from industry to these discoveries. It took a lot of work by many people to turn these extracts into drugs.

See the discussion and Bernard Munos' comment at: http://blogs.sciencemag.org/pipeline/archives/2015/10/05/natural-produc…

Listening to the announcement and press conference was painful when it had to be explained several times to journalists that Tu's work was not proof that traditional medicine worked.

And someday, if the discovery of Taxol were to warrant a Nobel Prize, it would be a vindication of the Yew tree.

Ibuprofen vindicates all allopathic medicine.

@#9 (Marry Me, Mindy):
And of the willow tree for aspirin, the cinchona tree for quinine, and the Madagascar periwinkle for vincristine and vinblastine - and so on.

NHK (the Japanese equivalent of the BBC) showed a clip in which a (non-Japanese) commentator suggested that Professor Tu had received little recognition until comparatively recently because she lacked "the three Ds" (a doctorate; foreign training - I don't remember quite how this is a D, but it was explained; and something else): she didn't fit into the Chinese academic establishment. Datta (cited in the original post) notes in his article that she is still not a member of any of the Chinese National Academies.

So, out of 2,000 products, they found one that had some effect, as long as you didn't prepare it the way the texts said to prepare it. You know, I don't think I like the odds there.

Not to mention penicillin and the many other antibiotics that came from soil extracts and whatnot. Those Ancient Chinese docs would have done better had they bothered to check out the mold on their rice.

Professor Tu had received little recognition until comparatively recently because she lacked “the three Ds” (a doctorate; foreign training – I don’t remember quite how this is a D, but it was explained; and something else): she didn’t fit into the Chinese academic establishment.

Almost nobody of her generation fits into the Chinese academic establishment. There was this unpleasant business called the Cultural Revolution going on, so most if not all Chinese universities were closed, and unless you were otherwise politically impeccable your Ph.D. degree would have been sufficient to make you suspect. China-USSR relations had started to chill by then, so getting a Russian or other East European doctorate wasn't an option. China's relations with the West hadn't thawed yet, so getting an American or West European doctorate wasn't an option either. Chinese graduate students started appearing in US universities in the early 1980s, and today it's common for Chinese to come to the US for undergraduate degrees (there are enough of them at my local university to support an Asian grocery store in an otherwise white-bread town).

Of course this demonstrates that the Cultural Revolution ended up wasting a lot of talent.

@#14 (Elliott):
"Red mold rice/red yeast rice" (rice fermented with Monascus purpureus) contains the cholesterol-lowering compound lovastatin, along with some other statins (monacolins). It's apparently a health food in China, but is banned in the US if it has more than nominal statin content.

Eric Lund@5:
October 7, 2015

Science-based medicine is glad to accept any treatment proposed by alt-med types, whether TCM or otherwise, that holds up under rigorous testing. Here, we have an example of something that passed the test.

It's an extremely poor example of that. TCM wasn't proposing anything: it was trundling happily along as it forever does, utterly uninterested and uncritical in determining which of its 'treatments' actually work or how they might be improved.

It's a much better example of an science-based researcher patiently spelunking the great rambling sinkholes of low-quality, anecdotal folk medicine, searching for recognizable hints of where and how there might be some interesting pharmacological activity possibly going on, then mercilessly beating on it until the active compound - if it does indeed turn out to exist - has been identified, extracted, synthesized, and improved.

If anything, the alt-med peddlers will dismiss the final pHARMa-manufactured result** as vastly inferior to their own wholesome organic all-natural treatment, due to souless reductionist science destroying its magical "whole-plant/animal/mineral" holisticism in their evil uncaring pursuit of patents and profit.

As Orac says, this is just a particularly good example of plain old pharmacognosy doing its job exactly as it's designed to do. The only credit TCM deserves is for inadvertently nudging the original researcher in what has ultimately proved to be a highly productive direction (as opposed to sending the poor sod up its infinitely more common dead ends). But this is only marginally more credit that you'd afford a stopped clock for at least being right twice a day; and curse the craven and fictitious press for presenting otherwise, just because a thrilling mystical narrative sells better to its idiot audiences than the slow undramatic truth.

(** While still crowing how it proves the efficacy of their own garbage product, of course. Never let it be said they aren't rigorously consistent in their own inconsistency.)

Many thanks to Orac for explaining the correct story, which is the same old story as for western real drugs.

ok. your comment about 'the chosen one' made me think of Tu isolating Artemisinin in parallel with the Episode 1 scene where they're testing Anakin for midichlorians. And, of course, all of the following fan-angst. "Stop trying to put scientific explanations to my fantasy world, you're ruining the magic!"

ok, at least in my head it seemed fitting.

@ Orac

Hope you enjoyed your day off from RI, recharged your batteries, etc. Kudos to the blinking box for having the wisdom to take care of itself. I've long been amazed by your ability to do all that you do, and I would still be so if new RI posts appeared, say 2-3 times a week instead of 5.

I hope I speak for more than a few minions in saying our appreciation for the blog, and desire that long may it run, means we're all for whatever it takes to keep the box free from dangers of burnout inducing overload, and realize that this is "a hobby", energy is a finite resource, and you have more important things to do.

Every RI post is a gift to public discourse. However often we get them, it's all good.

Be well, good sir.

So, out of 2,000 products, they found one that had some effect, as long as you didn’t prepare it the way the texts said to prepare it. You know, I don’t think I like the odds there.

To put it another way, Professor Tu discovered that 99.95% of products promoted by TCM practitioners are worthless.

Orac,

I want to agree with sadmar. Also, RI is getting me back to where I used to be. My commenting on your articles is the result of my health returning from battling prostate cancer and being grossly overweight (I've been told there is a link between the two). I've lost over 170 lbs and weighed 337 this morning; which is lightest I've been in over 12 years, I still have at least 112 lbs to lose.

It feels good to be more alive and thank you for allowing my posts.

I would like to point out that Treditional Chinese Medicine use liquid mercury as a way to prolong life. As a matter of fact, Mercury was used on some emperor, including China's first emperor.

https://en.wikipedia.org/wiki/Qin_Shi_Huang#Death_and_postmortem_events

https://en.wikipedia.org/wiki/Jiajing_Emperor#Legacy_and_death

I would like to see what the Alties think about Mercury.

#16-Derek
Yep--that's right. Lovastatin was first found in a strain of penicillium mold by Akira Endo in Japan back in the '70s, and again shortly later by researchers at Smith-Kline and Merck.

Naturally, the Nobel committee saw fit to recognize two other people (Brown & Goldstein) for their work on cholesterol metabolism instead.

Looking for new drugs by mining natural sources (mold, soil, plants, etc) or by investigating traditional medicines, is still done, but is less popular than it was a few decades ago. The returns have been diminishing for a quite a while.

herr doktor bimler@21:

So, out of 2,000 products, they found one that had some effect, as long as you didn’t prepare it the way the texts said to prepare it. You know, I don’t think I like the odds there.

To put it another way, Professor Tu discovered that 99.95% of products promoted by TCM practitioners are worthless.

And yet the Chinese have been very successfully selling those products for thousands of years. This is clear irrefutable proof of Big Pharma's massive incompetence: discarding 1999 perfectly saleable medical products just because they don't work.

Checkmate, pharma shills!

@ Rich Bly

I had Rouen-Y gastric-bypass bariatric surgery in 2010. I just made the minimum BMI to qualify for insurance coverage, and I probably wouldn't have done it for weight loss alone, but once I heard it would fix my awful problems with GERD (and attendant increased risk of nasty death to esophageal cancer) I was in.

Just as there's massive social stigma attached to obesity, there are powerful stigma against addressing it with surgery. The problem is exacerbated by the fact bariatrics can be a lucrative practice, and you hear plenty of horror stories about patients left worse-off by cut-and-run surgeons of dubious competence. Thankfully, my PCP knew was who, steered me away from the bozos in-town, and sent me an hour up the road to a guy running a "Center of Excellence" – which included an incredibly thorough pre-and-post-op program with dieticians, psychologists and mandatory support groups – leading to an long-term success-rate that was, indeed, excellent.

Not being an MD, I'm not recommending surgery for anyone for anything. I can only suggest that it's worth looking into, and report that many of the negatives you might hear associated with it are not significant concerns if you have the right doctor.

Glad to hear you're making progress, in any event!

Just another commenter happy to see you've written about this. I saw the write-up about the prize on Vox and read some of it anxiously until I saw they weren't going with the "Yay TCM" approach and in reading it it was very obvious Dr. Tu was working scientifically in her search for a remedy.

sadmar,

To treat my prostate cancer I had to loose over 100 lbs and the only way to this in time frame was to have bariatric surgery. I went through the process at U Of WA and was approved for surgery. However, my med insurance would not cover the surgery even with letters from my docs concerning the need to loose the weight for treatment or I might die. U of W wanted between 100,000 and 120,000 dollars for the surgery. I ended up going to Mexico and the cost was $5700 or about 20 times less.

I just wanted to throw this out there. Both points of this argument have their valid points, however this article posted here isn't a complete story. The way herbal chinese medicine works is through herbal formulations, not just single herbs. Yes each herb has its own properties (medicinal and others), however it is the combination of herbs together that create synergistic effects. In the same way that those in labs are working hard to extract specific molecules for treatment, combination treatment therapies are just as valid. For every drug/drug reaction or drug/herb reaction, there are millions of herb/herb reactions going on and by combining them opens the potential to unlock new chemical events within the body, those that possibly cannot be fully synthesized in a lab due to the environment inside ones body. Just food for thought.

Your excellent piece reminded me of the time I used the phrase "Chinese traditional medicine" in reference to an area of my research, only to be asked in disdain if I didn't mean TCM. When I attempted to explain the difference, pointing out that what most know as TCM is a recent extrapolation of Chairman Mao to offer inexpensive medicine to the masses, the young herbalist with whom I was speaking accused me of being steeped in western rational thinking and against the 'movement', giving new meaning to the phrase, communist propaganda. Not being soluble in water, what role artemisinin played, if any in the traditional use of the plant for fever must be called into question. For that matter, whether the plant is effective in lowering fever outside of those caused by malaria would also need to be examined.

@ Tim K: As incredible as it may seem, certain adherents of ayurvedic medicine believe mercury or cinnabar can be 'purified' to render it non-toxic, which may explain why high levels of mercury have turned up in some ayurvedic herbal products sold in the West. Go to PubMed and enter "mercury AND ayrurvedic" to see what I mean.

@Soro - I've heard people say things about the synergistic effects of chemicals within a single plant or those in a combination of plants. While this sounds plausible, I'm left with questions:
1. Has this ever been shown to be true in a rigorous way with the treatments in question?
2. Is there anything in the system of TCM that allows people to find those combinations by anything other than trial and error? If so, what is it and how was that shown to be true.

Thanks.

@Soro #29.

My Dad did a brief stint in synthesizing potential compounds from plants for medical use.

Guess what,

Scientists do understand and look for synergistic effects. One big part of does A treat B is looking at causation.

Is A necessary for B to get better,
Is A sufficient for B to get better (can it do it all by itself).

When you find that A is not in anyway sufficient you don't stop. Especially when whole plant extract is sufficient. You go looking for what is the combination that does it.

So this whole scientists cannot believe or understand synergy. For example in toxicology, one of my areas of expertise, where we note that compound A has X amount of toxic effect and compound B has Y amount of the same toxic effect but if you take A and B you don't get X+Y amount of toxic effect you get twice the additive toxicity or 3 times or 4 times...why so many things say don't drink alcohol when taking this medication. Usually the biggest warnings are when the effects are more than additive because scientists know synergistic effects can sometimes happen.

Now we don't believe they must in every case always happen so the more and more you add to one thing that you suspect might work the better the resulting combination must be. (so many proprietary blends out there that seem to be if you throw the whole kitchen sink of herbs in there it must be better even when what little we know of the active compounds suggest they may be antagonistic rather than synergistic).

Back to my Dad, when A wasn't doing it on his own he started investigating what is the combination that is needed for the desired effect. He didn't just say well if A can't do it by itself no matter what other data I have I will just stop because science demands that one and only one thing at a time can ever be used because reductionism or some such.

Soro,

It is possible that TCM herbal formulations exhibit synergistic effects, but you have to actually demonstrate that synergy exists in a particular formulation. The basis for the combination of herbs (the "king, minister, assistant, messenger" system) is the same mysticism that permeates the rest of TCM, rather than a scientific and evidence-based basis. As one promoter of alternative medicine explains it, "TCM herbs are not prescribed on the basis of their chemistry, as we would understand it in the West. Instead, they are used to introduce certain influences into the body, in order to balance and harmonize the patient's vital energy" (http://www.drpelletier.com/TBAM/excerpts/036-Chinese_Herbal.html). This is nonsense, of course, since the chemistry completely accounts for the action of botanical medicines. Therefore, there is no reason to expect any special synergy in these formulations, and rigorous evidence needs to be provided for claims of synergy, rather just assuming them to be true.

It's not just alcohol that can have a synergenic effect on some medications, but something like grapefruit-juice just as well, as my dad knows. Something he doesn't really like.

herr doktor bimler@ 21: 99.95% were worthless for what: treating malaria, or doing anything at all? I'm inclined to think it's the former, because the probability of a match between a specific disease and a specific source of compounds is always going to be low.

TimK @ 23: Mercury for longevity: That is the _perfect_ comeback to anti-vaxers who freak out about Thimerosal. "Do you believe in traditional Chinese medicine? Yes? Well, one of the traditional longevity drugs was mercury, so..."

Or to really rub it in: "...and do you also believe in homeopathy? Well, Thimerosal is a homeopathic dose of mercury, so it ought to be especially good as a life-extending drug!"

Lighthorse @ 30: There appears to be a strain of Maoism in some parts of the political left in the USA. It's subtle, but if one knows the material, one can spot it. That may account for some of what you observed, and I'm inclined to think it does, based on the herbalist's use of the word "movement."

Anyone who doesn't like "Western rational thinking" is welcome to explain why it doesn't work. (Asking them on the spot would be interesting.) And here I'm not talking about examples such as "rationalism can't tell you which music is better." Of course it can't, and it doesn't purport to do so.

Soro -

The way herbal chinese medicine works is through herbal formulations, not just single herbs.

So in that respect, what Tu did (isolate the active ingredient) is in fact not at all like "herbal chinese medicine." In fact, it sounds an awful lot like what those damned Western reductionists do, doesn't it?

Here's what I always wonder. Considering that that we are looking at 2000 mixtures for what is likely evidence of anti-pyretic effect. From which we select 600 mixtures. The question becomes how many of these fevers were actually malaria. If the majority weren't - then the fact that these mixtures were part of TCM seems like it could have occurred simply by chance.

Also, if they had to go through 600 to find a promising mixture - then it doesn't say very much about ethnomedicine in general.

Also, if they had to go through 600 to find a promising mixture – then it doesn’t say very much about ethnomedicine in general.

Not really; although it's not "ethnomedicine," the NCI program that yielded Taxol and Camptothecin went through over 100,000 plant samples.

Soro, #29
Even in Europe herbalists used mixtures of herbs to treat all sorts of ailments. Rarely, this mixtures had some sort of beneficial effect.

The English physician William Withering is credited for introducing foxglove as a treatment for "dropsy". Truly, he was shown by a herbalist how to treat the illness with a mixture of herbs, and it goes to his credit to have shown that the active ingredient were foxglove leaves.

The other herbs were of no use, even if his herbalist was using them since always.
Of course, today foxgloves leaves are not used anymore. We use nice little chemical pills with 0.2 mg of active drug.

https://en.wikipedia.org/wiki/William_Withering

Soro@29:

however this article posted here isn’t a complete story. The way herbal chinese medicine works is through herbal formulations, not just single herbs. Yes each herb has its own properties (medicinal and others), however it is the combination of herbs together that create synergistic effects.

Called it! Me@17:

alt-med peddlers will dismiss the final pHARMa-manufactured result as vastly inferior to their own wholesome organic all-natural treatment, due to souless reductionist science destroying its magical “whole-plant/animal/mineral” holisticism

Renate #36

Grapefruit juice is known to contain a whole bunch of organic compounds that affect chemical metabolism. The grapefruit compounds do this by interacting with enzymes in the liver and digestive system. The liver enzymes are there to metabolize all the toxic things that you eat or otherwise shove into your body, so your body can remove them and you won't kill yourself with that all-natural salad.

These grapefruit compounds can change how the liver metabolizes the drug or food chemical. This can make some drugs more active and others less active.

To make it more interesting, there's a lot of genetic variation on the liver enzymes. This variation often accounts for why people vary in how well they respond to a given drug or react to eating a food, and the types of side effects that they experience.

It's not really synergism at all--even a single chemical can interact with the body in a variety of ways. Investigating these and other interactions are why drug development takes time and many types of animal and clinical trials.

If a single chemical give complicated results in different people, then just imagine what happens when you put a complex mixture into your body.

Lecture over--hope you found this useful.

The way herbal chinese medicine works is through herbal formulations, not just single herbs. Yes each herb has its own properties (medicinal and others), however it is the combination of herbs together that create synergistic effects.

You'd think that after all that empirical observation of the effects of herbal combinations, they would have given up prescribing Aristolochia after noticing that it causes cancer no matter what it's combined with.

perodatrent@41

Of course, today foxgloves leaves are not used anymore. We use nice little chemical pills with 0.2 mg of active drug.

And thank goodness too. Nicely purified and precisely measured Digoxin is dangerous enough as it is.

Post-structuralism in action:

it had to be explained several times to journalists that Tu’s work was not proof that traditional medicine worked.

Language is a social construction. Linguistic expressions have multiple possible meanings, which get closed-off and narrowed-down by the exercise of social power, creating ideological effects in the 'preferred meaning' that remains.

So, here we are, using 'traditional medicine' to refer to something we know isn't traditional at all, and has a dubious claim to being medicine as well. But what are we supposed to do? The signifer 'TCM' has just been repeated, by so many people, in so many places, so many, many, many times, eventually it just sticks to the signified whether we like it or not. You protest for awhile: come up with alternate terms, or bracket the usage with quotation marks or appending 'so-called' to the front. But it gets old, and you wind up looking like some nit-picky pedant. So, eventually, you choose straightforward communication on the topic, which means employing the common terms the majority is using without making a fuss about it. And, thus, one more little grain of sand falls onto the social-construction pressure plate gradually tweaking the general sense of 'traditional' and 'medicine.' But when it comes down to any of us as individuals – trying to communicate, well, something else – we're just one against many, and our choices amount to a lose-lose, a problem either way.

Scientists tend to hold to an unexamined and naive logical positivism in the first place, and when confronted with post-structuralism, just double-down on it's central premise: the possibility of 'a neutral description language'. That is, they reject any notion that their language is anything but natural, transparent, reference to objective reality, reject that it too is an ideological social construction.

The problem, philosophically, is that continental thinkers recognized the central dilemma decades ago, and the logical positivists of the Vienna Circle set out to silence their critics by creating 'neutral description language' that would hold up as such under scrutiny and critique. They couldn't, and eventually threw in the towel.

Politically, the problem is that since when writers like Derrida and Barthes employed post-stucturalist theory in the form of criticism they called 'deconstruction', they focused on language use that supported social injustice – thus giving the impression that the application of power to rein in semiosis was always bad, and freeing all the 'repressed' meanings was always good. But Derrida was a Marxist. As such, he believed power was not always necessarily corrupt, that it could be taken by 'the people' and directed toward progress to a more just, equal, and democratic social order. Whether he himself articulated that in relation to deconstruction is irrelevant. 'Birmingham School' cultural studies mixes Derrida's insights along with Gramsci, Althusser, and a bunch of other folks to come up with the notion that "language is a site of struggle" between different social and cultural forces. It's not 'lose-lose'. The 'good guys' may be the underdogs, but the fight isn't over, and there's still opportunities for victory – which necessarily means bending language to the service of the greater good.

Not that I know how to do that. I'm just guessing scientists would look on the notion of 'bending language' for any purpose with a jaundiced eye. And I think that's a mistake.
_______

For all of its claims to 'just the facts' objecticity, at base science justifies itself by contending it serves the greater good. The facile exclamation "Science Works!" is generally followed by a listing of presumed-beneficial scientific achievements. This is blatant cherry-picking, as it takes virtually no effort whatsoever to come up with a different list where science did indeed 'work', but to serve many of the worst human impulses, and/or in ways that generated great harm as 'unintended consequences'.

However, it strikes me that sbm-advocacy has a moral center, whether its proponents like to admit it or not. Sbm discourse tends to focus on the factual/scientific 'wrongness' of woo. But a trollish commenter in another thread recently asked, "With all the many and mammoth wrongs in this world, why this focus...?" (my emphasis). While I take that query to be intended as a snarky rhetorical question, I also take it to be worth a serious answer. For factual/scientific wrongs are many and mammoth as well, ranging far beyond those addressed by the larger community of skeptics, and certainly of this blog. Why this focus? Why these scientific wrongs?

Is it not because woo hurts people so often? Steals their savings, their health, their lives? Is it not further that it preys on the weak, those least capable of helping themselves?

Yet even for Orac, who makes no effort I can see to hide his moral contempt for woo, 'the wrong of harm' often plays weak second-fiddle to 'the wrong of fact'. To me anyway this is cart-before-horse, especially in terms of reaching the non-science-literate general public. The 'wrong of harm' ought take the lead, and the 'wrong of fact' ought to be the backing support. IMHO.
______

Anyway, back to being stuck with 'traditional medicine' as a signifier for acupuncture and herbal hoo-hah. One of the things that happens over time with language is that in everyday usage, terms like this lose the connotations of their original referents. That's already beginning to happen with 'traditional medicine'. What's good about that formulation from an anti-woo POV is that it leaves the 'Chinese' out of it, as attacking anything associated with a racial Other is going to pose problems. The word 'traditional' already is anything but a straightforward positive. In uses like 'traditional marriage' it already evokes a conflict between forward-moving ideas and a retrograde nostalgia for an idealized past that never really existed.

Now, I'm not meaning to criticize anyone in sbm-land for how they've addressed or used the notion of 'traditional medicine', I just started thinking about it by chance reaction, and have been trying to work through those thoughts as I write. Anyway, here's my tentative conclusion: The opposition has captured the term "traditional medicine'. Any attempt to re-capture it, or explain why it's unwarranted (Mao, etc.) actually works i favor of the opposition by re-inforcing the positive connotations of 'traditional'. The proper rhetorical strategies would be either to abet the complete detachment of the term from any connotation beyond its current use, or to leverage the negative ones. 'Traditional Transportation' = donkey. 'Traditional Underwear' = corset "Traditional Bathroom" = open dung heap (etc. etc.); so why would I choose 'traditional medicine' over 'modern science'? Something like that. I.e. illustrating the problems of "argument from antiquity" in cutting analogies.

Oh boy, you're just another man speaking over the words of the woman who discovered it herself. You don't even realize you're doing it, but she said it was from TCM herself and you're going to say your opinion is more important than that?

Tu called artemisinin "a gift for the world’s people from traditional Chinese medicine," and urged researchers to turn to herbs in the search for cures for infectious diseases.

I looked up the original text of Ge Hong's "Handbook" and in context, it does distinguish between "immersion" and "boiling". Indeed, a few lines down it says:

Another recipe: Dichroa febrifuga 0.15kg. Use alcohol 3 litres, immerse 2-3 days, take out 300g and make the patient drink it. The patient would vomit it up; give a patient who is starting to get a fever 200g, and the fever will break. Using old wine is also fine. In an emergency, can alternatively boil [the remedy]. (My translation)
The last sentence is key.

I know it seems ambiguous how the handbook doesn't specify not to heat the water, but this was ~300AD and the written Chinese of the time would still be influenced by the very concise Classical form of the language (developed when writing was an expensive endeavor).

The Handbook itself is actually pretty hilarious, with remedies such as "split a pea pod, write 'sun' on on half and 'moon' on the other. Take one in each hand and you will be cured as soon as you swallow them; eat when the sun is shining inside from the northern window, don't let anyone else know."

"To cure any fever, this is the way: pick up a cock and for one hour make it make loud sounds; there's none [fever] that this won't cure".

"Take a spider. Mix with food into a ball and swallow."

And those are all fever remedies.

For reviving someone who suddenly "dies" (might include sudden loss of consciousness), we have:
"Cut off the tail of a pig, gather the blood and make the patient drink it. Then tie it up and use it as a pillow for the patient."

And advice that seem actually reasonable:
"Use a tube to blow into the throat, have multiple people alternate. Upon the air getting through, the person will live."

The Handbook includes many uses for excretions of various animals (including humans), and they seem most numerous in the section that deals with ingested poisons? Perhaps it's because they induce emesis? In one recipe, it even describes how to recognize the mouse droppings required ("the ones that are pointy at both ends, they are what we want"). I can't imagine a modern worshipper of TCM wanting to try them out.

As a one last aside, I think "liter" is a mistranslation from applying modern Chinese (where the character does translate to "liter") to near-Classical Chinese, where the unit might have described a significantly different amount. Because otherwise the handbook would have as a remedy for poison, "warm a liter of lard and make the patient drink it all."

@13 (Anthony): Actually, the claim is that initial extractions were ineffective because they deviated from the cold extraction method described in the Handbook. I also don't think the researchers had to go through 2000 herbs. If that number refers to the remedies listed in the books they consulted (as opposed to only the ones they seriously considered), a lot could have been rejected out of hand (e.g. write something on a body part and perform a ritual). And of the herbal remedies remaining, one might expect that some common herbs are present in multiple recipes if only because the books copied each other.

@#23 (Tim K): I think they used mercuric compounds instead of liquid mercury, because the Chinese word for the elixir referred, in (even) more ancient days, to a red stone (cinnabar?) and the stuff is usually depicted as a round pill.

And my two cents on the topic:
If we accept the premise that the rate of effective remedies in the old Chinese books is higher than random, we can treat it as a system with low signal to noise ratio, produced by large numbers of abysmally low quality studies. And guess what is really, really good at increasing the signal to noise ratio? Modern science armed with the extremely powerful tool that we call statistics. So we should run all the old remedies through scientific experiments, starting from the most promising ones; the ones that are not validated go into the discard pile. After the first round, model factors that predict effectiveness of a remedy and estimate the chance that each remedy in the discard pile was rejected in error, allowing us to reassess whether any of these merit a second chance (I believe this is an application of a posteriori Bayesian statistics).

"If we accept the premise that the rate of effective remedies in the old Chinese books is higher than random, we can treat it as a system with low signal to noise ratio, produced by large numbers of abysmally low quality studies."

We need to define what "higher than random" means in this context. Higher than simply picking some other chemical at random? Probably but I'm not certain that's really a fair comparison. TCM does add some information beyond chance (in this particular context) but I doubt it has much at all to do with medicinal effect. I suspect what a lot of ethnomedicine adds are more basic things like how well this is tolerated.

It's also worth mentioning that even a large series of low-quality studies do not necessarily increase the likelihood of one's hypothesis.

I would expect that the most obvious comparison would be to other plants, i.e. they would be more likely to have a medicinal effect on what they've been traditionally used for than a randomly selected plant. I suspect they would fare worse against designed compounds, but I don't know where the balance lays. I think you made a very good point about tolerability--which, now that I think about it, is a strong point in favour of testing these remedies, because lower probability of efficacy can be counterweighed by reduced risk of serious side effects.

I envision a large series of low-quality studies as flipping a set of coins, the vast majority of which are fair and a few of which are weighed to increase the likelihood of getting heads. In each study, you flip a coin a few times and make a guess on whether or not the coin is weighed, without the benefit of statistics. In this scenario, we would very many false positives and probably a few false negatives as well, but the set of coins you consider "weighed" probably has a larger proportion of weighed coins than the set we started out with. I think this is a meaningful, if over-simplified, abstraction of Chinese traditional medicine.

Of course, whether or not the resulting concentration of weighed coins is at a useful level is a different question, to which I do not have an answer.

It's worth noting that Dr. Tu is not a fluent English speaker, and may well be using "Traditional Chinese medicine" to mean Chinese herbal medicine rather than the hot/cold/wind etc. set of ideas. What is certain is that artemisin doesn't contain bear gall (for example), and patients are given it without someone first worrying about whether they have too much yang.

Sadmar # 46
Sadmar post looks nearly as long as Orac’s, but it seems to me that its core meaning is his will to shift SBM-advocates’ attention towards the harm that Alt Med can do, instead that focusing on the truth content of Alt Med practitioners.

This could be a sane proposal, if people who are expected to read SBM blogs were those more in need to be convinced that SBM is more useful than Alt Med to care for ill people.
Unfortunately, people that “know” that Alt Med is better will not be convinced from any quantity of evidence, so don’t bother to look up SBM blogs .

I think Orac has chosen a very useful mission: to inform people who may not know how to explain the strange facts that are heard of (Ben Carson’s advocacy of antivaxxers’ ideas, patients’ and parents’ choice that brings to dire results…).

I believe that evolution has endowed every social species with the means to obtain their social target: not to be put too far from alpha animal. In other species this target is mostly arrived to by means of physical force: the stronger wins. In our species it is got with rationality (both theoretical and practical): the less clever is kept lower in the social ladder.

When would be rational people read Orac thundering about the lack of rationality of Alt Med practitioners, they are delighted to hear that there are people on a far lower step than theirs. At least, so am I.

Jerry@47:

Oh boy, you’re just another man speaking over the words of the woman who discovered it herself.

Impressive ad-hom you got there, buddy. You can't rebut Orac's criticism so attack him as a mansplainer instead. So how does it feel, hiding behind the skirts of a woman just 'cos you're too damn chicken for a science fight?

In our species it is got with rationality (both theoretical and practical): the less clever is kept lower in the social ladder.

I am merely a human observer, but I have found this notion to be largely untrue.

Dr. Tu's discovery bears out a principle that a nurse I worked with succinctly expressed as "Even a blind pig sometimes finds an acorn." This is not a reference to Dr. Tu, but to the idea that rarely something valuable can be found in folk medicine.
The discovery of the vinca alkaloids used in cancer chemotherapy was mentioned above. They were originally derived from the Madagascar periwinkle, and found in a pharmacognosy expedition to that island - where it was used for stomach upset, not for cancer.
This is an especially bad time for TCM to get a boost, coming as it does with the news that the abundance of the TP53 gene in elephants appears to account for their low cancer rate. It's just what elephants needed - another excuse for the stupid and greedy to decimate the world's elephant population. I bet it won't be long before some charlatan or other will promote their product as increasing TP53 levels.

the news that the abundance of the TP53 gene in elephants appears to account for their low cancer rate

I see there's a proliferation of "Why Elephants Don't Get Cancer " headlines from journalists determined to drag the world down to their level of ignorance. Missing the point that elephants *do* get cancer, but they don't *all* get it despite their risk factors.

TP53 is also involved in Huntingdon's chorea, so wildly upregulating an apoptosis pathway is not necessarily a good thing.

First of all, I am totally excited that a woman whose specialty is related to my own has been awarded a Nobel, even if it’s Medicine & Physiology instead of the Chemistry prize.

That said, I agree with Orac that it’s not about “traditional Chinese medicine.” It’s “traditional medicinal chemistry.” We take leads wherever we can find them – other companies’ patents, dirt brought back from fellow chemists’ exotic vacations, plant or animal biological defense mechanisms, traditional medicinal literature. One has to start somewhere.

I first came across artemisinin in the 1990s in the synthetic chemistry literature. There were publications on both working towards the total synthesis and syntheses of analogs. I remember reading these papers because the chemical structure is kind of cool and challenging, and because even then I was aware that resistance of malaria to other treatments (e.g., quinine) was an issue – making artemisinin an exciting target molecule for organic synthesis, even to a recently graduated bachelor’s level research associate.

Developing new successful treatments for any condition is a challenge. If one is discovered and developed, does it matter what was the inspiration for its discovery? Yes, only in the sense that maybe that area may yield more discoveries. The next discovery will still need to be developed, and that’s still going to require science.

JP # 54
May be the current crop of Republican hopefuls will change your belief.
Or do they not seem the most clever in the bunch?

Below is article from the http://barfblog.com concerning traditional Indian medicine. How soon will this be the latest wooist craze in the US?

India’s Hindus won’t eat cows, but might drink their pee

Posted on October 10, 2015 by Doug Powell

In a concrete-block factory a few miles from one of the holiest spots on the Ganges, workers in hairnets and beanies slap caps on bottles zipping down an assembly line. A few feet further, another group sticks on no-nonsense, pharmaceutical-looking labels that read, “Divya Godhan Ark.”

Divya Godhan Ark.urineThe room reverberates with a droning, mechanical whir, and it’s redolent with a distinctive smell — like when you first open a jar of multivitamins, combined with a gas station men’s room.

That’s because the clear liquid in the bottles is purified cow’s urine — quite possibly the fastest growing alternative medicine in India these days.

“Cow’s urine is a diuretic. It helps in detoxification of the body, and many other beneficial effects are described in the Sanskrit scriptures, such as helping to expel excess bile,” says Anil Kumar, a vaidya — practitioner of Ayurvedic medicine — employed by the company Divya Pharmacy.

An Indian woman who tried to bring cow urine into the country [NZ] was fined $400 for not declaring it.

Because cows are so hard to find in New Zealand.

Cow’s urine is a diuretic.

Well, yes. There was some good reason the cow's kidneys wanted all of this stuff outside rather than inside. Who are we to question bovine wisdom?

Sanskrit scriptures

India needs toilet paper more than it needs cow pee.

Lightbulb...

herr doktor bimler@61: Not sacred ones.

(Unless you count Peter Jackson.)

Worse still, these TCM deniers 1) purposely put on the blinders that make themselves blind to the myriad of evidence (unlike the blind who have no way of seeing color); 2) most of the deniers are not even qualified to make an educated judgment of TCM: If you want to criticize the the string theory as hogwash, you must first have a Ph.D-level in-depth understanding of theoretical physics; you are not qualified to attack it after perusing a few pop science books or spend a weekend surfing the net reading up on they lazy man and the dummy's guide to theoretical physics. Yet, this is precisely what these TCM naysayers are doing. Which one of you have any true understanding of TCM to qualify you to attack TCM?

65 "...blind to the myriad of evidence..."

So, enlighten us with all this high quality evidence.

"...If you want to criticize the the string theory as hogwash, you must first have a Ph.D-level in-depth understanding of theoretical physics..."

Nonsense. You only need to ask one question: does string theory make testable predictions? No credentials required.

Often times, the TCM deniers sound so much like the blind trying to deny the existence, or, more accurately, the experience of color

It is easy to convince a cone achromat that colour is a valid phenomenon; he or she sees the evidence of other people making it to make useful distinctions. In this analogy, all the TCM practitioner needs to do is cure patients at a better rate than the placebo effect.

In this analogy, all the TCM practitioner needs to do is cure patients at a better rate than the placebo effect.

It would also be helpful to show that the underlying principles of TCM are in some way useful in diagnosing and treating illness.

@ herr doctor bimler:

I had many interesting conversations with a such a gentleman because my aunt married one. He often hilariously described how he had studied up in advance to appear as though he had no problem and how at sea he was when having to choose clothes. When I "tested" him he seemed to not have a clue other than lighter vs darker. Despite this, he managed to have meaningful employment in culinary arts, electronics and investigation ( a black and white private eye? yes!)
He was totally fabulous in many other ways as well.