tag:theconversation.com,2011:/uk/topics/traditional-chinese-medicine-2708/articles
Traditional Chinese medicine – The Conversation
2023-11-15T02:02:29Z
tag:theconversation.com,2011:article/216445
2023-11-15T02:02:29Z
2023-11-15T02:02:29Z
What is the PanaNatra line of painkillers and can herbal products effectively relieve pain?
<p>In an era where <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201926/#:%7E:text=Globally%2C%20it%20has%20been%20estimated,pain%20each%20year%20%5B1%5D">chronic pain affects millions worldwide</a>, the search for effective and safe pain relief has never been greater. </p>
<p><a href="https://www.pananatra.com.au/products/">PanaNatra</a> is a line of herbal products from <a href="https://www.haleon.com/">Haleon</a>, the makers of Panadol. Haleon <a href="https://www.pananatra.com.au/products/">claims</a> the three PanaNatra’s products, made from plant extracts, help manage and provide relief from mild joint aches, mild muscle pain, and mild pain affecting sleep. </p>
<p>They contain different combinations of four plants:</p>
<ul>
<li><em>Boswellia serrata</em> (contained in the joint and muscle products) </li>
<li><em>Curcuma longa</em> (in the joint and muscle products)</li>
<li><em>Piper nigrum</em> (just in the joint product)</li>
<li><em>Withania somnifera</em> (just in the sleep product).</li>
</ul>
<p>These products are “<a href="https://www.tga.gov.au/products/medicines/non-prescription-medicines/listed-medicines">listed medicines</a>” in Australia. This means the ingredients are considered broadly low risk, have been used in traditional medicine, and are manufactured to a high standard. But the manufacturer has not provided evidence to the government regulator that they work. </p>
<p>So can herbal ingredients effectively and safely relieve different types of pain? </p>
<h2>What does the evidence say?</h2>
<p>Let’s consider the evidence for the four main ingredients.</p>
<p><strong><em>Boswellia serrata</em></strong></p>
<p>Indian Frankincense (<em>Boswellia serrata</em>) has been described in traditional Indian Ayurveda texts since the 1st century AD. Key active compounds derived from the gum resin of the tree called <a href="https://pubmed.ncbi.nlm.nih.gov/27671822/">boswellic acids</a> are thought to have anti-inflammatory effects. </p>
<figure class="align-center ">
<img alt="Boswellia serrata" src="https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559173/original/file-20231113-25-2pl3tb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"><em>Boswellia serrata</em> is also known as Indian Frankincense.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/boswellia-serrata-73147612">Shutterstock</a></span>
</figcaption>
</figure>
<p>The <em>Boswellia serrata</em> dry concentrate extract (Rhuleave K) used in the Muscle Pain product contains 50 mg of the herb per tablet, whereas the Joint Pain product includes 33.3 mg as a different formulation (Apresflex).</p>
<p>A review of various human clinical trials using a range of formulations of this herb <a href="https://www-ncbi-nlm-nih-gov.ezproxy.library.sydney.edu.au/pmc/articles/PMC7368679/pdf/12906_2020_Article_2985.pdf">supports its ability</a> to reduce some types of pain and improve function in osteoarthritis. But a key finding of the study was that improvement only begins when <em>Boswellia serrata</em> is used continuously for four weeks and at a dose of at least 100–250 mg per day.</p>
<p>In a <a href="https://pubmed.ncbi.nlm.nih.gov/21060724/">clinical trial</a>, 100 mg daily of a <em>Boswellia serrata</em> gum-based product was found to reduce pain and improve physical functions for people with osteoarthritis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">9 signs you have inflammation in your body. Could an anti-inflammatory diet help?</a>
</strong>
</em>
</p>
<hr>
<p><strong><em>Curcuma longa</em></strong></p>
<p>Turmeric (<em>Curcuma longa</em>) has been used in Chinese and Indian medicine for at least 2,000 years. It contains a well-known chemical called curcumin, a natural compound used for its anti-inflammatory properties, especially for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273926/">osteoarthritis</a>. </p>
<figure class="align-center ">
<img alt="Turmeric root (Curcuma longa)" src="https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559174/original/file-20231113-17-p914do.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"><em>Curcuma longa</em> is also known as turmeric.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/turmeric-root-curcuma-longaherb-plant-786438259">Shutterstock</a></span>
</figcaption>
</figure>
<p>Turmeric compounds such as curcumin are <a href="https://journals.sagepub.com/doi/10.1177/1759720X221124545">often combined</a> with <em>Boswellia serrata</em> compounds to improve their anti-inflammatory effects to reduce pain. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/33511486/">review of 16 different clinical trials</a> found turmeric extracts were effective for knee osteoarthritis. </p>
<p>A similar conclusion was drawn from a <a href="https://www.sciencedirect.com/science/article/pii/S0965229921001163">review of 11 clinical trials</a> which examined the use of curcuminoids (of which curcumin is one) for one to four months. It found curcuminoids had similar pain-relieving qualities as non-steroidal anti-inflammatory based drugs. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/these-5-foods-are-claimed-to-improve-our-health-but-the-amount-wed-need-to-consume-to-benefit-is-a-lot-116730">These 5 foods are claimed to improve our health. But the amount we'd need to consume to benefit is... a lot</a>
</strong>
</em>
</p>
<hr>
<p><strong><em>Piper nigrum</em></strong></p>
<p>Black pepper (<em>Piper nigrum</em>) contains the chemical <a href="https://www.mdpi.com/2076-3417/9/20/4270">piperine</a>, which has anti-inflammatory properties.</p>
<figure class="align-center ">
<img alt="Piper Nigrum (peppercorn)" src="https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559177/original/file-20231113-23-f91rga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"><em>Piper nigrum</em> is also called black pepper.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pepper-piper-nigrum-peppercorn-common-1158781747">Shutterstock</a></span>
</figcaption>
</figure>
<p><em>Piper nigrum</em> is often added to curcumin products to improve the absorption of curcumin, as is the case with the PanaNatra Joint Pain product.</p>
<p>For musculoskeletal pain, a <a href="https://pubmed.ncbi.nlm.nih.gov/32664057/">preliminary human trial</a> that examined the effects of a 1,000 mg daily dose of Rhuleave K (the extract used in PanaNatra) found it was as effective as paracetamol. </p>
<p>But the study was not placebo-controlled and the dose of paracetamol given (1,000 mg per day) was below the recommended daily intake for pain relief.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/knee-pain-heres-why-it-happens-and-how-you-can-fix-it-211858">Knee pain: here’s why it happens and how you can fix it</a>
</strong>
</em>
</p>
<hr>
<p><strong><em>Withania somnifera</em></strong></p>
<p><em>Withania somnifera</em> (also called Ashwagandha) has been used in <a href="https://medlineplus.gov/druginfo/natural/953.html">traditional Indian Ayurvedic medicine</a> for thousands of years to reduce stress and ease inflammation. </p>
<figure class="align-center ">
<img alt="Withania somnifera plant, commonly known as Ashwagandha (winter cherry)" src="https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559178/original/file-20231113-21-zdguhr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ashwagandha, or <em>Withania somnifera</em>, is sometimes called winter cherry.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/withania-somnifera-plant-commonly-known-ashwagandha-2237392831">Shutterstock</a></span>
</figcaption>
</figure>
<p>One of the key chemicals appears to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8705790/">withaferin A</a> which interferes with the inflammatory signalling pathway. </p>
<p>PanaNatra’s Pain and Sleep product contains 300 mg per tablet of a <em>Withania somnifera</em> extract called KSM66.</p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/32818573/">human trial</a> found a daily 600 mg dose of <em>Withania somnifera</em> extract improved sleep quality and helped in managing insomnia.</p>
<p><a href="https://assets.cureus.com/uploads/original_article/pdf/25730/1612429507-1612429503-20210204-18590-tdgx00.pdf">In a separate trial</a>, <em>Withania somnifera</em> was found to improve sleep quality, again when administered at a dose of 600 mg per day.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-ayurveda-to-biomedicine-understanding-the-human-body-85631">From Ayurveda to biomedicine: understanding the human body</a>
</strong>
</em>
</p>
<hr>
<h2>So what does this mean?</h2>
<p>Whether, and how well, a herbal medicine works is largely dependent on the formulation (how it’s made and the extract used) and the dose provided. The same herb used in one formulation may result in a different outcome than a different formulation containing the same herb. </p>
<p>It’s also important to note that effectiveness for one type of pain does not mean a product will work for other types of pain. </p>
<p>Overall, similar herb extracts to those that have been included in the PanaNatra products do have some evidence that they work for pain and sleep. Whether they work for you will depend on a number of factors including the effectiveness of the PanaNatra formulation, how much you take, and the extent of your pain.</p>
<h2>Are they safe?</h2>
<p>PanaNatra needs to be used carefully by some patients. </p>
<p>Overall, there is insufficient human data to recommend any of these herbal ingredients in pregnancy or lactation. In fact there is some evidence that <em><a href="https://www.sciencedirect.com/science/article/pii/S2210803321000142">Withania somnifera</a></em> may be unsafe to use in pregnancy, and other than the amounts commonly found in food, turmeric and its compounds are <a href="https://www.nccih.nih.gov/health/turmeric">not considered safe</a> to use in pregnancy either. </p>
<p>The herbs may also impact the effectiveness and safety of other medicines. For example, the blood levels of the cancer drug <a href="https://link.springer.com/article/10.1007/s00280-023-04504-z">tamoxifen may be reduced</a> when taken concurrently with turmeric supplements. </p>
<p><em>Withania somnifera</em> has been associated with drowsiness and cases of <a href="https://www.mdpi.com/1660-4601/20/5/3921">liver toxicity</a>.</p>
<p><em>Curcuma longa</em> products, including formulations containing curcumin and piperine, have also been associated with liver toxicity. As such, Australia’s Therapeutic Goods Administration has proposed <a href="https://consultations.tga.gov.au/medicines-regulation-division/low-neg-risk-2023-2024/user_uploads/tga---low-negligible-risk-annual-consultation-2023-2024---final.pdf">adding warning labels</a> to any products that contain those ingredients. But this discussion is ongoing and a decision won’t be made until next year. </p>
<h2>Bottom line</h2>
<p>While there is a long history of traditional use of the herbs in the PanaNatra products, there is limited high-quality scientific evidence for the effectiveness and safety for these specific products. </p>
<p>Pregnant and breastfeeding women should not take these products, and you should not exceed the daily dose recommended by the manufacturer. </p>
<p>If you have an underlying health condition, or are taking other medication, before you try them, consult your doctor or pharmacist to check if these products are suitable for you.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-you-know-whats-in-the-herbal-medicine-youre-taking-72726">Do you know what's in the herbal medicine you're taking?</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/216445/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design, and testing.</span></em></p><p class="fine-print"><em><span>Joanna Harnett is an academic University of Sydney’s Faculty of Medicine and Health Pharmacy School where she teaches and conducts research in the field of traditional, complementary, and integrative medicine (TCIM). She has received research funds from universities, organisations, and/or industry for TCIM research and education and received payments for providing expert advice about TCIM to industry, government bodies and/or non-government organisations, and/or spoken at workshops, seminars and/or conferences for which registration, travel and/or accommodation has been paid for by the organisers.
The institutes, centres and universities associated with the authors receive research grants, donations and endowments from foundations, universities, government agencies, individuals, and industry. Sponsors and donors have provided untied funding to advance TCIM education and research. This viewpoint article was not undertaken as part of a contractual relationship with any donor or sponsor.
</span></em></p>
PanaNatra is a line of herbal products from the makers of Panadol. But can herbal ingredients relieve different types of pain?
Nial Wheate, Associate Professor of the School of Pharmacy, University of Sydney
Joanna Harnett, Lecturer (Complementary Medicines) Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/184200
2022-12-20T13:36:59Z
2022-12-20T13:36:59Z
China’s lucrative orchid industry is a test for the nation’s commitment to conservation
<figure><img src="https://images.theconversation.com/files/501948/original/file-20221219-26-qngzj1.jpg?ixlib=rb-1.1.0&rect=35%2C0%2C4744%2C3182&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sorting collected _Dendrobium_ flowers in Guizhou province, China, June 28, 2020.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/villager-sorted-out-the-collected-dendrobium-flowers-news-photo/1223450934">Photo Costfoto/Future Publishing via Getty Images</a></span></figcaption></figure><p>China is well known for its <a href="https://press.uchicago.edu/ucp/books/book/distributed/C/bo26248951.html">medicinal use of wild plants</a>, a tradition that dates back thousands of years. These traditional Chinese medicines include many wild orchids, some quite showy. </p>
<p>Typically, orchids are <a href="https://collegeofphysicians.org/programs/education-blog/dendrobium-orchids-and-chinese-medical-practices">consumed alone or mixed with other herbs</a> in tea or soup. The health benefits vary depending on species; conditions for which orchids are used include <a href="https://doi.org/10.1177/0141076807100012014">immune system boosting, hypertension and stroke</a>. </p>
<p>Many of these medicinal orchids are among the 40-plus species in the genus <em>Dendrobium</em>. In recent decades, supplies of wild-sourced medicinal <em>Dendrobium</em> orchids have declined steadily, with <a href="https://doi.org/10.1007/s10531-014-0661-2">shortages of some types</a>. This is occurring in the limestone regions of Guizhou and Guangxi, the main area where <em>Dendrobium</em> has grown naturally, due to a combination of overharvesting by collectors and habitat loss.</p>
<p>I am an <a href="https://www.researchgate.net/profile/Hong-Liu-7">ecologist</a> and lead several research projects in southwestern China, where the nation’s first orchid nature preserve is located in a zone with a highly diverse assortment of orchid species. In 2017, China released a <a href="https://www.biodiversity-science.net/EN/10.17520/biods.2017144">Biodiversity Red List</a> of endangered species found within its borders. It included 68 threatened <em>Dendrobium</em> species but did not mention overharvesting as a factor for their decline, even though I and other researchers have shown that <a href="https://doi.org/10.1016/j.biocon.2019.108204">trade in wild-harvested orchids</a> is <a href="https://doi.org/10.1007/s12231-019-09463-2">very active in China</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/VOxJuf2fnKE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Many of the herbs used in traditional Chinese medicine are hand-picked by people in remote places.</span></figcaption>
</figure>
<p>In my view, China’s Biodiversity Red List <a href="https://doi.org/10.1016/j.biocon.2020.108484">significantly underestimates wild harvest</a> as a threat to Chinese orchids. The government has taken encouraging steps on this issue recently, but its actions reflect challenges that are relevant to conserving many wild species, such as <a href="https://doi.org/10.3390/su11154194">balancing use and conservation</a>. The fate of China’s <em>Dendrobium</em> orchids thus offers clues about what China is prepared to do to conserve its many endangered plants and animals.</p>
<h2>From forests to cities</h2>
<p>Farmers typically collect wild medicinal orchids to sell to middlemen or in rural markets. From there, the plants often move to bigger medicinal plant trading hubs or <a href="https://doi.org/10.1016/j.biocon.2019.108204">flower-and-bird markets in major Chinese cities</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/501938/original/file-20221219-26-if94lw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A flower twines around a tree trunk." src="https://images.theconversation.com/files/501938/original/file-20221219-26-if94lw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/501938/original/file-20221219-26-if94lw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=903&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501938/original/file-20221219-26-if94lw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=903&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501938/original/file-20221219-26-if94lw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=903&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501938/original/file-20221219-26-if94lw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1135&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501938/original/file-20221219-26-if94lw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1135&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501938/original/file-20221219-26-if94lw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1135&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A semi-wild <em>Dendrobium</em> orchid growing on a tree in China’s Guangdong province.</span>
<span class="attribution"><span class="source">Hong Liu</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>The total trade volumes of medicinal orchids are not well documented, but likely vary by species. Available records showed that <a href="https://doi.org/10.1007/s10531-014-0661-2">medicinal <em>Dendrobium</em> species trade</a> peaked in the late 1980s at about 660 short tons (600 metric tons) yearly. More recent evidence suggests that wild medicinal <em>Dendrobium</em> are being <a href="https://doi.org/10.1016/j.biocon.2019.108204">traded across borders</a> between China and southeast Asian countries, probably because the plants’ populations are dwindling in China. </p>
<h2>Industrial cultivation</h2>
<p>Although China faces many <a href="https://www.cfr.org/backgrounder/china-climate-change-policies-environmental-degradation">well-known sustainability challenges</a>, it is working to position itself as an environmental leader. This is especially true for <a href="https://theconversation.com/is-china-ready-to-lead-on-protecting-nature-at-the-upcoming-un-biodiversity-conference-it-will-preside-and-set-the-tone-193681">protecting wild species</a>: In 2019, China sought and won the role of host for the planned 2021 Conference of Parties to the U.N. Convention on Biodiversity. That meeting, originally located in the Chinese city of Kunming, was <a href="https://www.nytimes.com/2022/12/19/climate/biodiversity-cop15-montreal-30x30.html">held in Montreal</a> in late 2022 after several COVID-19 delays.</p>
<p>Actions on orchid conservation reflect this push. On Sept. 7, 2021, China released a <a href="http://www.forestry.gov.cn/main/5461/20210908/162515850572900.html">revised list of National Key Protected Wild Plants</a>, which included about 1,100 species. The new list <a href="https://www.orchidspecialistgroup.com/_files/ugd/556eb4_6b78d3c4ebfe4177b04862e36a0ea7b4.pdf">added 291 Chinese orchid species</a>, in sharp contrast to the preceding version, which did not protect any orchids.</p>
<p>All 96 species of Chinese <em>Dendrobium</em> are on the list, which means that collecting them is subject to national <a href="http://lawinfochina.com/Display.aspx?lib=law&Cgid=15408">regulations on wild plant protection</a>. It remains to be seen how effectively these regulations will be enforced.</p>
<p>China also has encouraged production of commercially valuable animals and plants on farms to meet market demand and reduce pressure on wild species. For orchids and many other species, this strategy has produced <a href="https://doi.org/10.1111/cobi.13216">mixed results</a>.</p>
<p>Growers are now cultivating <em>Dendrobium</em> orchids, including Tie Pi Shi Hu (<em>D. catenatum</em>), one of four “fairy herbs” that are documented in ancient herbal books. This process is mostly done in industrial greenhouses. In 2020, China produced <a href="https://m.huaon.com/detail/628889.html">33,000 short tons (30,000 metric tons) of <em>Dendrobium</em> orchids</a>, with an estimated market value of ¥12 billion RMB, or about $US1.7 billion. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/501945/original/file-20221219-18-7wztgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two women wearing face masks fill crates with plants" src="https://images.theconversation.com/files/501945/original/file-20221219-18-7wztgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501945/original/file-20221219-18-7wztgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501945/original/file-20221219-18-7wztgj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501945/original/file-20221219-18-7wztgj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501945/original/file-20221219-18-7wztgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501945/original/file-20221219-18-7wztgj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501945/original/file-20221219-18-7wztgj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Workers pick <em>Dendrobium</em> orchids in a commercial greenhouse in Cixi, in east China’s Zhejiang province, May 21, 2018.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/may-21-2018-staff-members-pick-dendrobium-in-cixi-east-news-photo/961393060">Xinhua/Xu Yu via Getty Images</a></span>
</figcaption>
</figure>
<p>This output has only partly satisfied market demand, and orchid consumers view cultivated orchids as an inferior option. As a result, these plants command a much lower market price than their wild counterparts. </p>
<p><em>Gastrodia elata</em>, a threatened orchid used in traditional Chinese medicine, is a good example. <a href="https://doi.org/10.1007/s12229-010-9045-9">Mass artificial cultivation techniques</a> for this species were developed as early as the 1980s, but have not ended wild collection.</p>
<h2>Forest-grown orchids</h2>
<p>One alternative would be to ban use of these threatened orchids. But <a href="https://theconversation.com/restricting-trade-in-endangered-species-can-backfire-triggering-market-booms-124869">usage bans on other wild species</a> have produced mixed results. Depending on factors such as market demand and species biology, <a href="https://doi.org/10.1111/cobi.13216">bans may not be necessary or desirable</a>. </p>
<p>It has been more productive for China to supplement mass orchid cultivation by raising high-value medicinal and edible plants under the canopy of well-managed native forests. These cultivation operations, which could be called “forest grown” or “forest farmed,” are <a href="https://doi.org/10.1007/s10531-014-0661-2">ecologically beneficial</a> because farmers can adopt harvesting methods that enable the plants to persist and reproduce. <a href="https://www.fs.usda.gov/nac/assets/documents/research/publications/2011ginsengforest.pdf">Forest-grown ginseng in the U.S.</a> is an example of this approach.</p>
<p>Forest-grown <em>Dendrobium</em> farming is popular now in <a href="https://www.hanspub.org/journal/PaperInformation.aspx?paperID=39920">Guizhou and Fujian provinces</a>. The provincial government is encouraging it as a way of reducing poverty. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/501940/original/file-20221219-18-dhdqih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man rappels down a cliff near trailing flowers" src="https://images.theconversation.com/files/501940/original/file-20221219-18-dhdqih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/501940/original/file-20221219-18-dhdqih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501940/original/file-20221219-18-dhdqih.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501940/original/file-20221219-18-dhdqih.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501940/original/file-20221219-18-dhdqih.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501940/original/file-20221219-18-dhdqih.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501940/original/file-20221219-18-dhdqih.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Planting orchids on a cliff in Fujian province, southern China. Most <em>Dendrobium</em> species grow on rocks or other plants rather than in the soil.</span>
<span class="attribution"><span class="source">Hong Liu</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Forest farming helps producers save money by eliminating or reducing the need for pesticides. In turn, farming without chemicals enables them to sell their plants in organic and other niche markets. It also helps to conserve the target species and the forests where they grow, and preserves native forest diversity. Promoting forest farming can drive interest in forest stewardship and raise awareness about indigenous plants.</p>
<p>This strategy also has some disadvantages. Plants grow more slowly under forest canopies than in shade houses, and yields generally are lower. This means that forest-farmed products must be sold at a premium to be profitable. For now, I believe these semi-wild cultivation operations should be considered experimental.</p>
<p>Conserving high-value plants while also supporting local livelihoods will require officials to think about both <a href="https://doi.org/10.1007/s11538-014-0030-z">ecological and social impacts</a>. If China can find a way to achieve sustainable use of medicinal orchids, it could set a conservation model for other countries that face similar challenges.</p><img src="https://counter.theconversation.com/content/184200/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hong Liu received funding from the Guangxi Chairman’s Foundation (09203-04), the Mohamed bin Zayed Species Conservation Fund 0905324 and Fairchild Tropical Botanic Garden.</span></em></p>
Dendrobium orchids are familiar to most people in bouquets, but they are in high demand in China for use in traditional medicines. Can Beijing find ways to grow these threatened plants sustainably?
Hong Liu, Professor of Earth and Environment, Florida International University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/194903
2022-11-18T01:41:28Z
2022-11-18T01:41:28Z
We created the world’s first donkey embryo using IVF in a bid to save species from extinction
<figure><img src="https://images.theconversation.com/files/496040/original/file-20221118-21-8wy465.jpg?ixlib=rb-1.1.0&rect=0%2C40%2C5463%2C3596&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>You may not realise it, but the world’s donkeys are in trouble: many domestic breeds and wild species are headed for extinction. But my colleagues and I have developed a scientific breakthrough that may contribute to saving them.</p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S0093691X22004447?via%3Dihub">We created</a> the world’s first successful donkey embryo using in-vitro fertilisation (IVF). The embryo, from an endangered European breed, is frozen in liquid nitrogen. We’re now searching for a suitable female donkey to grow the embryo into a baby.</p>
<p>We hope to apply our findings to help conserve other endangered animals. Hopefully one day, we’ll have a genetic bank of embryos that form a “frozen zoo” – creating another weapon in our conservation ass-enal, so to speak.</p>
<figure class="align-center ">
<img alt="donkey face against blue sky" src="https://images.theconversation.com/files/496044/original/file-20221118-25-kjhzwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496044/original/file-20221118-25-kjhzwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496044/original/file-20221118-25-kjhzwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496044/original/file-20221118-25-kjhzwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496044/original/file-20221118-25-kjhzwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496044/original/file-20221118-25-kjhzwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496044/original/file-20221118-25-kjhzwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Researchers have developed a scientific breakthrough that may help save donkeys.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Donkeys in decline</h2>
<p>Donkeys share the same genus with horses and zebras. They’re thought to have been <a href="https://www.pnas.org/doi/10.1073/pnas.0709692105">domesticated</a> about 6,000 years ago and used for transport and food redistribution. They were particularly essential in the overland trade in Africa and western Asia.</p>
<p>Domestic donkeys are <a href="https://spana.org/au/blog/what-are-working-donkeys/">still used</a> for transport in parts of Asia, South America and Africa. They are also kept for meat and milk production and as companion animals.</p>
<p>Seven of the 28 European domestic breeds are critically endangered and 20 are endangered. Populations of wild donkey species are also dwindling.</p>
<p>There are several reasons for this. People are using and breeding them less, and their grazing land has declined. Donkeys are also slaughtered for “ejiao”, a key ingredient in traditional Chinese food and remedies produced from collagen in donkey skin.</p>
<p>There’s an urgent need to improve donkey conservation programs to increase the animal’s numbers and distribution, and to broaden the genetic pool.</p>
<p>My research team set out to produce donkey embryos in the laboratory, in the hope of helping to repopulate species. I worked with colleagues from Argentina’s National University of Río Cuarto, and Spain’s University of Córdoba and Autonomous University of Barcelona. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/feral-desert-donkeys-are-digging-wells-giving-water-to-parched-wildlife-159909">Feral desert donkeys are digging wells, giving water to parched wildlife</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="traditional Chinese food made from donkey hide" src="https://images.theconversation.com/files/496043/original/file-20221118-17-q8bz6r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496043/original/file-20221118-17-q8bz6r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496043/original/file-20221118-17-q8bz6r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496043/original/file-20221118-17-q8bz6r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496043/original/file-20221118-17-q8bz6r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496043/original/file-20221118-17-q8bz6r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496043/original/file-20221118-17-q8bz6r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Traditional Chinese food and remedies, such as the food pictured, use ‘ejiao’ produced from collagen in donkey skin.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What we did</h2>
<p>An embryo is the group of cells that form when a female egg is fertilised by male sperm. </p>
<p>Creating a viable donkey embryo is not easy. Once an egg is fertilised in the lab, it has only a 5% to 10% chance of growing into a good embryo that can be implanted into a female. By comparison, for horses the success rate is up to 30%.</p>
<p>We used an IVF process known as intracytoplasmic sperm injection (ICSI). It involves injecting a single sperm into the centre of an egg using very fine, specialist equipment.</p>
<p>Importantly, we added a step to the process. Before fertilising the egg, we immersed it for two days in fluids from the female donkey’s ovary. This simulates ovary conditions and gives the egg the molecules and hormones it needs to grow.</p>
<p>After three years of work, we produced the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0093691X22004447?via%3Dihub">world’s first viable donkey embryo</a>. It is currently frozen in a lab at the University of Cordoba in Spain.</p>
<p>Our research suggests that using ovary fluids as an egg matures in the lab supports the IVF process and could be more likely to lead to a viable embryo. These findings are a step forward in donkey conservation.</p>
<p>We produced the embryo by combining donkey semen with an egg from a different part of Spain. This aimed to avoid inbreeding problems that can occur when trying to reproduce an endangered species.</p>
<p>We hope to create more viable embryos and find suitable female donkeys to implant before the breeding season ends next year.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/human-reproductive-technologies-like-sperm-freezing-and-ivf-could-be-used-to-save-threatened-species-148637">Human reproductive technologies like sperm freezing and IVF could be used to save threatened species</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="four donkeys in dry landscape" src="https://images.theconversation.com/files/496045/original/file-20221118-17-jzu9ro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496045/original/file-20221118-17-jzu9ro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496045/original/file-20221118-17-jzu9ro.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496045/original/file-20221118-17-jzu9ro.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496045/original/file-20221118-17-jzu9ro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496045/original/file-20221118-17-jzu9ro.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496045/original/file-20221118-17-jzu9ro.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The researchers hope to find suitable female donkeys to implant before the breeding season ends.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>So what next?</h2>
<p>Throughout my research career, I’ve used assisted reproductive technologies to improve the genetic progress in a range of domestic animals. In 2020, for example, I and my colleagues reported the first in vitro <a href="https://dx.plos.org/10.1371/journal.pone.0238948">zebra embryos</a>. We now have ten frozen zebra embryos in storage, including clones.</p>
<p>We hope to build on our donkey embryo development, using IVF to improve the prospects of other endangered species. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/scientists-release-world-first-dna-map-of-an-endangered-australian-mouse-and-it-will-help-to-save-it-189629">Scientists release world-first DNA map of an endangered Australian mouse, and it will help to save it</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/194903/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andres Gambini does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The embryo is frozen in liquid nitrogen until a suitable female donkey is found to grow it into a baby.
Andres Gambini, Senior Lecturer, School of Agriculture and Food Science, The University of Queensland
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/192590
2022-10-26T12:29:17Z
2022-10-26T12:29:17Z
Drugs – 4 essential reads on how they’re made, how they work and how context can make poison a medicine
<figure><img src="https://images.theconversation.com/files/489907/original/file-20221016-16-3m74ut.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Constraining drugs to a single function in the body may be limiting their full potential.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/red-and-white-pharma-pill-pattern-on-pastel-blue-royalty-free-image/1288588418">Israel Sebastian/Moment via Getty Images</a></span></figcaption></figure><p>Pandemics and disease outbreaks put a spotlight on the hurdles researchers face to get a drug on the shelves. From finding prospective drug candidates to balancing time and financial pressures with ensuring safety and efficacy, there are many aspects of drug development that determine whether a treatment ever makes it out of the lab. </p>
<p>Broadening the definition of “medicine” and where it can be found, however, could help expand the therapeutic options available for both researchers and patients.</p>
<p>Here are four facets of how drugs are developed and how they work in the body, drawn from stories in The Conversation’s archive.</p>
<h2>1. Matching drug to target</h2>
<p>The most effective drugs are, in a sense, the product of good matchmaking – they bind to a specific disease-causing receptor in the body, elicit a desired effect and ideally ignore healthy parts of the body.</p>
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<figcaption><span class="caption">Factors such as your age, genetics and diet can affect how well your body processes a drug.</span></figcaption>
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<p>Drugs <a href="https://theconversation.com/how-do-drugs-know-where-to-go-in-the-body-a-pharmaceutical-scientist-explains-why-some-medications-are-swallowed-while-others-are-injected-182488">travel through the bloodstream</a> to reach their targets. Because of this, most drugs circulate throughout the body and can bind to unintended sites, potentially causing undesired side effects.</p>
<p>Researchers can increase the precision and effectiveness of a drug by designing different ways to take it. An inhaler, for example, delivers a drug directly to the lungs without its having to travel through the rest of the body to get there.</p>
<p>Whether patients take drugs as prescribed is also essential to ensuring the right dose gets to where it needs to be often enough to have a desired effect. “Even with all the science that goes into understanding a disease well enough to develop an effective drug, it is often up to the patient to make it all work as designed,” writes pharmaceutical scientist <a href="https://www.researchgate.net/profile/Thomas-Anchordoquy">Tom Anchordoquy</a> of the University of Colorado Anschutz.</p>
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Read more:
<a href="https://theconversation.com/how-do-drugs-know-where-to-go-in-the-body-a-pharmaceutical-scientist-explains-why-some-medications-are-swallowed-while-others-are-injected-182488">How do drugs know where to go in the body? A pharmaceutical scientist explains why some medications are swallowed while others are injected</a>
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<h2>2. Searching for drug candidates</h2>
<p>Researchers have discovered a number of drugs by chance, including <a href="https://www.pbs.org/newshour/health/the-real-story-behind-the-worlds-first-antibiotic">penicillin</a> for bacterial infections, <a href="https://www.bbc.com/future/article/20200928-how-the-first-vaccine-was-born">vaccines for smallpox</a> and <a href="https://doi.org/10.1038/nrcardio.2017.172">warfarin</a> for blood clots. While serendipity still plays a role in modern drug discovery, most drug developers take a systematic approach.</p>
<p>Scientists typically start by identifying a particular molecular target, usually receptors that trigger a specific response in the body. Then, they look for chemical compounds that react with that target. Technology called <a href="https://theconversation.com/discovering-new-drugs-is-a-long-and-expensive-process-chemical-compounds-that-dupe-screening-tools-make-it-even-harder-175972">high-throughput screening</a> allows researchers to quickly test thousands of potential drug candidates at once. Compounds that match screening criteria advance to further development and refinement. Once optimized for their intended use, compounds go on to safety and efficacy testing in animals and people.</p>
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<figcaption><span class="caption">Scientists have been isolating medicinal compounds from natural products for centuries.</span></figcaption>
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<p>One way to ease the search for optimal drug candidates is to work with compounds that are already optimized to work in living beings. <a href="https://theconversation.com/nature-is-the-worlds-original-pharmacy-returning-to-medicines-roots-could-help-fill-drug-discovery-gaps-176963">Natural products</a>, derived from organisms like microbes, fungi, plants and animals, share similar structures and functions across species. Though not without their own development challenges, they could aid the search for related compounds that work in people.</p>
<p>“There are thousands of microorganisms in the ocean left to explore as potential sources of drug candidates, not to mention all the ones on land,” writes medical chemist <a href="https://scholar.google.com/citations?user=8_T1ueYAAAAJ&hl=en">Ashu Tripathi</a> of the University of Michigan. “In the search for new drugs to combat antibiotic resistance, natural products may still be the way to go.”</p>
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Read more:
<a href="https://theconversation.com/nature-is-the-worlds-original-pharmacy-returning-to-medicines-roots-could-help-fill-drug-discovery-gaps-176963">Nature is the world's original pharmacy – returning to medicine's roots could help fill drug discovery gaps</a>
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<h2>3. A drug by any other name may be just as effective</h2>
<p>Existing drugs can find a second (or third, fourth and fifth) life through repurposing. </p>
<p>Most drugs <a href="https://theconversation.com/many-medications-affect-more-than-one-target-in-the-body-some-drug-designers-are-embracing-the-side-effects-that-had-been-seen-as-a-drawback-184922">have many functions</a> beyond what researchers originally designed them to do. While this multifunctionality is often the cause of unwanted side effects, sometimes these results are exactly what’s needed to treat a completely unrelated condition.</p>
<p>Sildenafil, for example, failed to treat severe chest pain from coronary artery disease, but proved to be potent at inducing erections as Viagra. Similarly, thalidomide, a compound that caused birth defects in thousands of infants around the world as a morning sickness drug, found redemption as a cancer treatment. </p>
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<figcaption><span class="caption">While thalidomide was disastrous for morning sickness, it has proved effective for other diseases.</span></figcaption>
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<p>Because drugs inherently have more than one function in the body, <a href="https://theconversation.com/repurposing-generic-drugs-can-reduce-time-and-cost-to-develop-new-treatments-but-low-profitability-remains-a-barrier-174874">repurposing existing drugs</a> can help fill a gap where pharmaceutical companies and other developers cannot or will not. <a href="https://scholar.google.com/citations?user=iDKZaA4AAAAJ&hl=en">Gregory Way</a>, a researcher at the University of Colorado Anschutz, uses artificial intelligence to predict the various effects a drug can have and believes that this lack of specificity is something to explore rather than eliminate. Instead of trying to home in on one specific target, he suggests that scientists “embrace the complexity of biology and try to leverage the multifaceted effects drugs can offer.”</p>
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Read more:
<a href="https://theconversation.com/many-medications-affect-more-than-one-target-in-the-body-some-drug-designers-are-embracing-the-side-effects-that-had-been-seen-as-a-drawback-184922">Many medications affect more than one target in the body – some drug designers are embracing the 'side effects' that had been seen as a drawback</a>
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<h2>4. Poison as medicine</h2>
<p>If so many drugs can have toxic effects in the body, be it through side effects or taking the wrong dose or for the wrong condition, what determines whether a drug is a “medicine” or a “poison”?</p>
<p>Biomedical scientists evaluate drugs based on their active ingredient, or a specific compound that has a specific effect in the body. But reducing medicines to just a single molecule ignores another important factor that determines whether a drug is therapeutic – the context in which it is used. Opioids treat intractable pain but can lead to debilitating and lethal addiction when improperly administered. Chemotherapy kills tumors but causes collateral damage to healthy tissues in the process.</p>
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<span class="caption">Aconite is a poisonous herb that was used to treat cold symptoms in ancient Chinese medical practice.</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/resource/lcnclscd.2012402216.1A010/?sp=3">Library of Congress, Asian Division, Chinese Rare Books</a></span>
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<p>Another pharmaceutical paradigm, <a href="https://theconversation.com/poison-or-cure-traditional-chinese-medicine-shows-that-context-can-make-all-the-difference-163337">traditional Chinese medicine</a>, has historically acknowledged the malleability of drugs through the use of poisons as therapeutics. </p>
<p><a href="https://scholar.google.com/citations?user=4q0hYSwAAAAJ&hl=en">Yan Liu</a>, a medical historian at University of Buffalo who studies this practice, notes that ancient texts did not distinguish between poisons and nonpoisons – rather, Chinese doctors examined drugs based on a continuum of potency, or ability to harm and heal. They used different processing and administration techniques to adjust the potency of poisons. They also took a personalized approach to treatment, aware that each drug works differently based on a number of different individual factors.</p>
<p>“The paradox of healing with poisons in traditional Chinese medicine reveals a key message: There is no essential, absolute or unchanging core that characterizes a medicine,” Liu writes. “Instead, the effect of any given drug is always relational – it is contingent on how the drug is used, how it interacts with a particular body and its intended effects.”</p>
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Read more:
<a href="https://theconversation.com/poison-or-cure-traditional-chinese-medicine-shows-that-context-can-make-all-the-difference-163337">Poison or cure? Traditional Chinese medicine shows that context can make all the difference</a>
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<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/192590/count.gif" alt="The Conversation" width="1" height="1" />
Despite technological advancements, many challenges remain in getting a drug from lab to pharmacy shelf. Reframing what is a “medicine” could expand treatment options for researchers and patients.
Vivian Lam, Associate Health and Biomedicine Editor
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/181939
2022-06-27T03:47:10Z
2022-06-27T03:47:10Z
Physio ‘dry needling’ and acupuncture – what’s the difference and what does the evidence say?
<figure><img src="https://images.theconversation.com/files/468636/original/file-20220614-22-2dsj01.jpg?ixlib=rb-1.1.0&rect=17%2C250%2C5725%2C3569&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/woman-relaxes-acupuncture-procedure-acupuncturist-600w-1635120196.jpg">Shutterstock</a></span></figcaption></figure><p>Physiotherapists are increasingly offering needling therapies in addition to their standard care. Many Australian <a href="https://australian.physio/research/prf/translation/five-facts-about-acupuncture-and-dry-needling-musculoskeletal-pain">physiotherapists</a> in private practice now offer dry needling or Western medical acupuncture as part of a treatment approach.</p>
<p>Is it just a fad or does science support it?</p>
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Read more:
<a href="https://theconversation.com/health-check-why-do-my-muscles-ache-the-day-after-exercise-41820">Health Check: why do my muscles ache the day after exercise?</a>
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<h2>Needling, three ways</h2>
<p>Physiotherapists can be trained to use dry needling, Western acupuncture and/or traditional acupuncture. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/23801002/">Dry needling</a> involves penetrating the skin with needles to altered or dysfunctional tissue in order to improve or restore function. This often involves needling muscle trigger points to activate a reflexive relaxation of the muscle. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/28739020/">Western acupuncture</a> uses traditional needling <a href="https://www.sciencedirect.com/science/article/pii/S2005290110600143">meridians</a> (the ancient idea of energy channels through the body) and trigger points. But these ideas are applied to Western understandings of anatomy. In Western acupuncture, points are stimulated to create local tissue changes, as well as spinal and brain effects. The goals is to trigger pain-relieving chemicals, muscle activation or relaxation.</p>
<p>Even though traditional acupuncture points are used with this style of needling, Western acupuncture is not viewed as traditional Chinese medicine. </p>
<p><a href="https://healthtimes.com.au/hub/pain-management/44/research/kk1/acupuncture-for-pain-management/1581/">Traditional acupuncture</a> uses meridian lines or other points based on traditional Chinese medicine assessment methods and approaches. </p>
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<a href="https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="chinese medicine chart with lines through body" src="https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A traditional Chinese medicine acupuncture chart from the 1800s.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/xk6jb43t">Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>All physiotherapists trained in either acupuncture or dry needling meet safety standards which are viewed as within scope by the <a href="https://www.ahpra.gov.au/">Australian Health Practitioners Regulatory Agency</a> and the <a href="https://www.physiotherapyboard.gov.au/">Physiotherapy Registration Board</a>. These standards cover the level of training required, registration to practice and safety standards that include needle safety and hygiene to protect the public. </p>
<p>Minor reported <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015026/#:%7E:text=Examples%20of%20minor%20adverse%20reactions,pain%20during%20or%20after%20treatment.">side effects</a> related to acupuncture including pain and bleeding or bruising from needle insertion are fairly common. But major adverse events – pneumothorax (collapsed lung), excessive bleeding, prolonged aggravation – are rare. </p>
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Read more:
<a href="https://theconversation.com/this-ancient-chinese-anatomical-atlas-changes-what-we-know-about-acupuncture-and-medical-history-140506">This ancient Chinese anatomical atlas changes what we know about acupuncture and medical history</a>
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<h2>What’s needling good for?</h2>
<p>Research into the effectiveness of acupuncture and dry needling is variable. Some studies show comparable results between dry needling and acupuncture, while others show more favourable results for one or the other depending on the condition being treated. </p>
<p>A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001351.pub2/full?highlightAbstract=dry%7Cdri%7Cneedl%7Cneedling">review</a> that assessed the effects of acupuncture and dry needling for the treatment of low-back pain found they may be useful add-on therapies but could not make firm conclusions due to a lack of quality trials. </p>
<p>Another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600071/#CIT0034">review</a> reported the growing popularity of dry needling world wide and across disciplines and points out that many questions still remain regarding the use of needling. </p>
<p>For <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001218.pub3/full?highlightAbstract=acupuncture%7Cmigraine%7Cmigrain%7Cacupunctur">migraine</a> and <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007587.pub2/full?highlightAbstract=acupuncture%7Cheadach%7Ctension%7Cacupunctur%7Cheadache%7Ctype">tension</a> headaches, experts say acupuncture seems to reduce the frequency and intensity of attacks – though more research is needed to compare it to other treatments.</p>
<p>Acupuncture and dry needling may reduce pain and improve function for people with <a href="https://pubmed.ncbi.nlm.nih.gov/17224820/">neck pain</a>. A systematic review found significant differences between acupuncture and “sham acupuncture” (which is performed away from acupuncture points) when used to treat <a href="https://pubmed.ncbi.nlm.nih.gov/22965186/">certain types of chronic pain</a>. However, some research only shows <a href="https://pubmed.ncbi.nlm.nih.gov/33066556/">small and temporary</a> relief for neck pain with dry needling.</p>
<p>Results from randomised control trials support the use of needling for <a href="https://pubmed.ncbi.nlm.nih.gov/27062955">shoulder pain</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/32301166/">tennis elbow</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/32186030/">osteo arthritic knee pain</a>. But a recent systemic review of research reported only weak evidence to support needling to treat <a href="https://pubmed.ncbi.nlm.nih.gov/33760098/">plantarfasciitis and chronic ankle instability</a>. </p>
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<a href="https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man lies on treatment bed while physio inserts needles into his back" src="https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An increasing number of physiotherapists offer dry needling or acupuncture treatment.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<h2>Not just for sporting injuries</h2>
<p>Similarly, small randomised control trials have shown acupuncture and dry needling might reduce <a href="https://pubmed.ncbi.nlm.nih.gov/17095133/">problematic jaw pain</a> (<a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disorder-tmd#:%7E:text=Temporomandibular%20disorders%20(TMD)%20are%20disorders,may%20result%20in%20temporomandibular%20disorder.">temporo mandibular disorder</a>) and improve mouth opening.</p>
<p>Systematic reviews have reported needling and acupuncture were safe and effective recommendations for the treatment of broad conditions of <a href="https://www.healthline.com/health/tendinopathy">tendinopathy</a> (the breakdown of collagen in tendons) and <a href="https://pubmed.ncbi.nlm.nih.gov/30787631/#:%7E:text=At%20follow%2Dup%20in%20the,for%20the%20management%20of%20FM.">fibromyalgia</a> (chronic pain in the muscles and bones).</p>
<p>For women’s health, acupuncture has been shown to be effective for reducing pain with <a href="https://pubmed.ncbi.nlm.nih.gov/29879061/">periods</a>, compared to no treatment or non-steroidal pain relief medications – but the research had design limitations.</p>
<p>Though <a href="https://www.cochrane.org/CD002962/PREG_acupuncture-or-acupressure-induction-labour#:%7E:text=Acupuncture%20involves%20the%20insertion%20of,with%20onset%20of%20labour%20contractions.">widely used</a> in pregnancy, research into the use of acupuncture to <a href="https://pubmed.ncbi.nlm.nih.gov/32032444/">induce labour</a> reports it may increase satisfaction with pain management and reduce pain intensity. But it may have little to no effect on the rates of caesarean or assisted vaginal birth.</p>
<p>In summary, it appears needling techniques – whether dry needling or acupuncture – generally show positive effects over no treatment or “sham” treatments, but more research and high quality trials are needed. </p>
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<h2>Just one part of a treatment program</h2>
<p>Needling <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001351.pub2/full?highlightAbstract=dry%7Cdri%7Cneedl%7Cneedlin">may be useful</a> as part of multimodal care – that is, when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780149/">more than one treatment</a> is used in conjunction to treat a problem. </p>
<p>Physiotherapists may combine needling therapies with exercise prescription, hands-on care including massage, mobilisations and manipulations, and taping techniques. They may also employ therapies that apply external energy such as ultrasound, laser, transcutaneous (under the skin) electrical nerve stimulation and biofeedback.</p>
<p>Finally, while the various needling techniques all use a filiform needle (with a solid filament as opposed to a hollow bore needle), the styles with each can be quite different. Ask what style of needling is being employed to treat you, and if you have a history of finding one style works better for you, discuss this with your practitioner.</p><img src="https://counter.theconversation.com/content/181939/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Dry needling and Western acupuncture don’t incorporate traditional chinese medicine philosophies – but may be helpful for pain and releasing muscle tension.
Wayne Hing, Professor, Physiotherapy, Bond University
Leigh McCutcheon, Lecturer, Bond University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/163337
2021-08-23T12:04:24Z
2021-08-23T12:04:24Z
Poison or cure? Traditional Chinese medicine shows that context can make all the difference
<figure><img src="https://images.theconversation.com/files/415906/original/file-20210812-24899-jszn8m.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Poisons have been used in traditional Chinese medicine for over two millennia.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/chinese-herbal-medicine-royalty-free-image/157691909">4X-image/E+ via Getty Images</a></span></figcaption></figure><p>Poisons today typically evoke notions of harm and danger – the opposite of medicines for healing. Yet <a href="http://bioinf-applied.charite.de/supertcm/">traditional Chinese medicine</a>, which has been in practice for <a href="http://cup.columbia.edu/book/traditional-chinese-medicine/9780231175012">over two millennia</a>, used a large number of poisons to treat a variety of illnesses. Chinese doctors knew that what makes a drug therapeutic isn’t just its active ingredient – it depends on how you use it.</p>
<p>Biomedical researchers <a href="https://doi.org/10.1038/d41586-019-01726-1">skeptical of the safety and efficacy of traditional Chinese medicine</a> might not be surprised that Chinese doctors historically prescribed poisons. Some believe that the drugs used in traditional Chinese medicine often contain <a href="https://theconversation.com/are-traditional-chinese-medicines-safe-and-legal-6373">hidden toxic ingredients detrimental to health</a>.</p>
<p>But this blurred boundary between poison and medicine is not unique to traditional Chinese medicine. <a href="https://wwnorton.com/books/9781324002505">Chemotherapy</a> uses toxic drugs to treat cancer. And the <a href="https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis">U.S. opioid epidemic</a> offers a sobering reminder of how a class of FDA-approved medicines used to treat chronic pain became lethal poisons through improper administration. Conversely, <a href="https://www.penguinrandomhouse.com/books/529343/how-to-change-your-mind-by-michael-pollan/">certain psychedelics</a> deemed illegal today have ignited new interest in the medical community as potential treatments for anxiety, addiction and depression.</p>
<p>I am a <a href="https://yan-liu.net/">medical historian</a> who examined the <a href="https://uwapress.uw.edu/book/9780295748993/healing-with-poisons/">therapeutic use of poisons in Chinese medicine</a> in my recent book. Based on my research, I believe that Chinese doctors in the past recognized the healing capacity of poisons while being fully aware of their potential to kill. Understanding this practice compels modern biomedicine to reconsider how “medicine” is defined today.</p>
<h2>What is an active ingredient?</h2>
<p>The debate on the safety and efficacy of traditional Chinese medicine often centers on the <a href="https://www.sciencedaily.com/releases/2014/06/140605093305.htm">active ingredient</a> of a drug. The U.S. Food and Drug Administration <a href="https://www.fda.gov/drugs/drug-approvals-and-databases/drugsfda-glossary-terms#A">defines an active ingredient</a> as “any component that provides pharmacological activity or other direct effect in the diagnosis, cure, mitigation, treatment, or prevention of disease, or to affect the structure or any function of the body of man or animals.”</p>
<p>In other words, the active ingredient is a specific chemical considered to make up the essence of a drug. Because it carries the responsibility of curing a target disease, it’s <a href="https://dx.doi.org/10.1111%2Fj.1476-5381.2010.01127.x">used as the gold standard</a> to evaluate the utility of a drug in modern pharmaceutics.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415920/original/file-20210812-25200-1qj4ufq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two traditional Chinese medicine practitioners weigh and wrap herbs at Tong Ren Tang." src="https://images.theconversation.com/files/415920/original/file-20210812-25200-1qj4ufq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415920/original/file-20210812-25200-1qj4ufq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415920/original/file-20210812-25200-1qj4ufq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415920/original/file-20210812-25200-1qj4ufq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415920/original/file-20210812-25200-1qj4ufq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415920/original/file-20210812-25200-1qj4ufq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415920/original/file-20210812-25200-1qj4ufq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Understanding the poison-medicine paradox opens up more doors for treatment.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-preparation-of-traditional-chinese-medicine-at-the-news-photo/527442670">Mike Kemp/Corbis News via Getty Images</a></span>
</figcaption>
</figure>
<p>There is value to identifying active ingredients in drug discovery, including those in traditional Chinese medicine. Scientist <a href="https://theconversation.com/is-the-2015-nobel-prize-a-turning-point-for-traditional-chinese-medicine-48643">Tu Youyou won the 2015 Nobel Prize in Physiology or Medicine</a> for isolating malaria drug artemisinin from an herb used in traditional Chinese medicine. In the same vein, medical researcher <a href="https://doi.org/10.1007/s11427-013-4487-z">Zhang Tingdong and his team</a> identified arsenic trioxide as an effective treatment for leukemia by studying drug formulas in traditional Chinese medicine.</p>
<p>Despite these success stories, reducing a medicine to a single molecule is rather limited. This reductionist approach ignores the context in which a drug is used, which plays a crucial role in its end effects. To appreciate this perspective, it is necessary to go back in history to see how poisons were understood and used in premodern China.</p>
<h2>Poisons in traditional Chinese medicine</h2>
<p>The Chinese word for poison is <a href="https://www.zdic.net/hans/%E6%AF%92">“du” (毒)</a>. Unlike its negative meaning today, ancient texts written 2,000 years ago <a href="https://uw.manifoldapp.org/read/healing-with-poisons-d74f2492-5f8c-4898-8cd1-546023f82ab8/section/aaaebb7f-02be-48d2-a705-63f8cfc4e7c9">used the word to denote potency</a>, or the ability to both harm and heal. There was no categorical distinction between poisons and nonpoisons in traditional Chinese medicine – they acted in a continuum defined by level of potency.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/410863/original/file-20210712-27-cocyqt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Historical illustration of a plant with leaves and large tubers" src="https://images.theconversation.com/files/410863/original/file-20210712-27-cocyqt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410863/original/file-20210712-27-cocyqt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=796&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410863/original/file-20210712-27-cocyqt.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=796&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410863/original/file-20210712-27-cocyqt.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=796&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410863/original/file-20210712-27-cocyqt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1000&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410863/original/file-20210712-27-cocyqt.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1000&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410863/original/file-20210712-27-cocyqt.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1000&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Aconite is a poisonous herb that was used to treat cold symptoms in ancient Chinese medical practice.</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/resource/lcnclscd.2012402216.1A010/?sp=3">Library of Congress, Asian Division, Chinese Rare Books</a></span>
</figcaption>
</figure>
<p>The dual potential of poisons laid the foundation for their use in medicine. Chinese doctors strategically deployed potent poisons to cure everything from blood clots to abdominal pain to epidemic diseases. For example, <a href="https://www.gbif.org/species/8244887">aconite (“fuzi” 附子), a highly poisonous herb grown in southwest China</a>, was one of the most often prescribed medicines in the medieval era. <a href="https://press-files.anu.edu.au/downloads/press/n7034/html/08-fluid-being/index.html">Mercury</a> was another poison used regularly in both medicine and alchemy to eliminate worms and prolong life. Overall, <a href="https://doi.org/10.34758/yazp-kz74">poisons consistently made up about 20% of the drugs</a> in the ever-expanding Chinese pharmacopeia throughout the imperial era, speaking to their crucial role in healing.</p>
<p>One way Chinese doctors used poisons for healing was through the principle of <a href="https://uw.manifoldapp.org/read/healing-with-poisons-d74f2492-5f8c-4898-8cd1-546023f82ab8/section/23b03b49-e064-4226-bd75-cb7ab99e6353">using poison to attack poison (“yi du gong du” 以毒攻毒)</a>. In their eyes, these powerful substances could target and eliminate specific disease entities like worms inside the body. They believed the strong sensations induced by poisons marked a process of purifying the body of its harmful burdens.</p>
<h2>The context in which a drug is used matters</h2>
<p>Chinese doctors in the past were not looking for an active ingredient that defined the usefulness of any given substance. Rather, they considered the effect of each drug highly malleable. No better example illustrates this way of thinking than the medical use of poisons. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/410870/original/file-20210712-38010-1mwxo4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of a master surrounded by his disciples who are processing drugs" src="https://images.theconversation.com/files/410870/original/file-20210712-38010-1mwxo4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410870/original/file-20210712-38010-1mwxo4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=876&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410870/original/file-20210712-38010-1mwxo4g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=876&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410870/original/file-20210712-38010-1mwxo4g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=876&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410870/original/file-20210712-38010-1mwxo4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1101&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410870/original/file-20210712-38010-1mwxo4g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1101&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410870/original/file-20210712-38010-1mwxo4g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1101&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Illustration of drug processing in a 16th-century pharmaceutical text.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/exgqkteq">Wellcome Collection</a></span>
</figcaption>
</figure>
<p>Doctors in China were keenly aware of how the effect of a poison varied greatly depending on how it was prepared and administered. Accordingly, they <a href="https://uw.manifoldapp.org/read/healing-with-poisons-d74f2492-5f8c-4898-8cd1-546023f82ab8/section/69b5c6b9-093c-4946-8c17-3fd351944c06">developed a variety of methods</a> – such as dosage control, mixing with other ingredients and other drug processing techniques – to mitigate a poison’s potency but still preserve its efficacy.</p>
<p>Chinese doctors were also aware that poisons worked differently from person to person. The same drug could have different effects depending on the patient’s gender, age, setting, emotional status and lifestyle. For example, <a href="https://www.happygoatproductions.com/sun-simiao-">eminent 7th-century physician Sun Simiao (孫思邈)</a> offered remedies specific to women and the elderly.</p>
<p>Using a poison outside of its prescription often proved deadly. For instance, <a href="https://uw.manifoldapp.org/read/1abfa74f-92a6-4b5c-aec9-c2ab99bc1f74/section/49ca5b73-2a40-4fb1-88bd-412d8677e2c4">Five-Stone Powder, or “Wushi San” (五石散)</a>, a psychedelic drug that contains arsenic, was one of the most popular medicines in medieval China. Despite medical recommendation that it be used only as a last resort to treat emergencies, many at the time regularly consumed it to invigorate their bodies and illuminate their minds. Unsurprisingly, this misuse led to numerous deaths. Going beyond its restricted usage, a poison could easily kill.</p>
<h2>Beyond the active ingredient</h2>
<p>The paradox of healing with poisons in traditional Chinese medicine reveals a key message: There is no essential, absolute or unchanging core that characterizes a medicine. Instead, the effect of any given drug is always relational – it is contingent on how the drug is used, how it interacts with a particular body and its intended effects.</p>
<p>[<em>Over 100,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>Medicines are fluid substances that defy stable categorization. Looking beyond the biomedical standard of the active ingredient could help doctors and researchers pay more attention to the context of how medicines are used. This will allow for a more nuanced understanding of healing.</p>
<p>Ultimately, there is more to a medicine than its active ingredient. Poisons in traditional Chinese medicine, I hope, teach a compelling lesson.</p><img src="https://counter.theconversation.com/content/163337/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yan Liu does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The usefulness of a drug is typically measured by its active ingredient. But traditional Chinese medicine shows that there’s more to healing than using the right chemical.
Yan Liu, Assistant Professor of History, University at Buffalo
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/165650
2021-08-17T15:37:07Z
2021-08-17T15:37:07Z
Nine things you don’t know about seahorses
<figure><img src="https://images.theconversation.com/files/416501/original/file-20210817-15-esfbag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many seahorses mate for life, and males are always pregnant.</span> <span class="attribution"><span class="source">Steven L Gordon/Shutterstock</span></span></figcaption></figure><p>Seahorses have long been a popular attraction in public aquariums, but they remain mysterious. They are a fish with a difference in that they swim in an upright, vertical position. They have flexible necks and long, tubular snouts that point downward, giving them the appearance of a horse’s head. Their lower bodies form a flexible, prehensile tail, <a href="https://science.sciencemag.org/content/349/6243/aaa6683/tab-pdf">which is square</a> in outline and can wrap around objects. There are at least 47 known species, all belonging to the genus <em>Hippocampus</em>, a Greek term that means “horse sea monster”. So what else should we know about this creature?</p>
<h2>They are notoriously poor swimmers</h2>
<p>Seahorses do not have the typical pelvic, anal and caudal fins that provide thrust, lift and steering on most fishes. Instead, they propel themselves by <a href="https://www.cambridge.org/core/journals/journal-of-the-marine-biological-association-of-the-united-kingdom/article/on-seahorse-locomotion/88B9A9E160475AF2CA29EE68F1E9CA79">fluttering their small dorsal fin</a> at about 35 beats per second. Steering is accomplished using even smaller pectoral fins on the sides of their head. These pectoral fins look like ears and add to the horse-like appearance of the head. Their inability to swim well means that they sometimes die of exhaustion in rough seas .</p>
<h2>They are masters of camouflage</h2>
<p>Seahorses typically inhabit shallow seagrass and algae beds and coral reefs in temperate and tropical waters around the globe, typically between 45 degrees north and 45 degrees south of the equator. They are <a href="https://www.scielo.br/j/ni/a/mfHWgyKpcYq6XW6vjZWLD7C/?lang=en">masters of camouflage</a>. They can change their colour over time, and some species can even grow filaments (called cirri) along their body to help them blend in with their surroundings. </p>
<h2>They ambush their prey</h2>
<p>Camouflage is critical to seahorses as they use it to ambush their prey. They remain motionless and camouflaged, anchored to seagrasses, corals or sponges by their prehensile tail, and suck up any passing plankton or fish fry with their long, tubular snout. <a href="https://www.nature.com/articles/ncomms3840?version=meter+at+null&module=meter-Links&pgtype=article&contentId=&mediaId=&referrer=&priority=true&action=click&contentCollection=meter-links-click">Seahorses must be within a few millimetres of their prey</a> to capture them, so remaining undetected is paramount.</p>
<h2>They have no stomach</h2>
<p>Seahorses have no teeth and no stomach – a trait they share with a few species of wrasses, a species of brightly coloured marine fish. Food passes through their digestive tract so rapidly that they need to <a href="https://link.springer.com/article/10.1007/s11160-019-09549-z">eat almost constantly</a> to live and grow. A single seahorse can eat up to 3000 brine shrimp per day. </p>
<h2>They can move their eyes independently</h2>
<p><a href="https://digital.csic.es/bitstream/10261/98500/1/Tesis_Andreu_Blanco.pdf">Seahorse eyes move independently</a>, giving them a nearly 360-degree field of vision, so they can literally keep one eye out for predators while using the other to follow prey. However, they are bony and indigestible, and their only real predators are crabs, which grab seahorses with their pincers, and humans who collect them for traditional medicine, curios, and aquarium pets.</p>
<h2>They mate for life</h2>
<p><a href="https://www.scielo.br/j/rbbio/a/GMwV6wvPHjFBwtrhVBDtJhn/?format=pdf&lang=en">Most seahorses are monogamous</a> and mate for life, although a few species are polygamous and change mates from one breeding cycle to the next. However, all species of seahorse mate with only one individual per breeding cycle. Seahorses can often be seen swimming in pairs with their tails linked together. They engage in a courtship dance which includes spinning around, swimming side by side and changing colours. This can last up to nine hours. This courtship dance is repeated daily, strengthening the bond between the mated seahorse pair.</p>
<h2>The males give birth to babies</h2>
<p>Seahorses are one of the few animal species on Earth in which the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/bies.20626?casa_token=Wvxr2vVnE8UAAAAA:jntA_m4uSevtum69ck3LBfQ1huQ0L-I4zayDq9OoXxk5FV4Z1_txc83FIA5uPRFE2PnfL_NxKvawYRk">male bears the unborn young</a>. During mating, the female deposits her eggs into the male oviduct (yes, the males have an oviduct), which sits in a pouch in the male’s abdomen, called a brood pouch. The male <a href="https://theconversation.com/the-secret-sex-life-and-pregnancy-of-a-seahorse-dad-46599">carries the eggs</a> in his brood pouch until they hatch into fully formed, miniature seahorses and are released into the water. Males can give birth to as few as five or as many as 1,500 young. </p>
<h2>The males are continuously pregnant</h2>
<p><a href="https://d1wqtxts1xzle7.cloudfront.net/44956087/Male_pregnancy_and_the_formation_of_seah20160421-16830-15twlbk-with-cover-page-v2.pdf?Expires=1628784093&Signature=KK2K%7Ehc8bhmRZ44CYVREPVnr8ZpizEEUPhd9S21JsLwelQk3amdTE5Yq1zqWII9jaNqOdElv6DrM6hYEe0ydHB-xp2pBgXVXtNpQrB-x3c-dDv7o-mlxjUz5QcnePqy4iptSoqefsNotxWT-2QAyupgh-2L5jzOftEm1JuQxgDXHIAnmlCN3y7gnfwB32vO9Em0ezHX4qRR4pF2XDbUq9KnQ4spWnWlU0O8ZmpWIt9-YvMzkaExnY1jR6E0wiIvLj7hzSyMuIISJBTgLlCiteWXJzDkwv5xDm43x6xkX0PdbCWNqEzIrNVH6f21S51Kh1cWqwfT8-DhYj2HW9wGUjQ__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA">Male pregnancy</a> allows the females to continue making eggs while the male is pregnant with the young, allowing seahorses to reproduce more quickly. As soon as the male gives birth, the female will deposit more fertilised eggs in his brood pouch.</p>
<h2>They are in trouble</h2>
<p>The life history and ecology of seahorses make them particularly vulnerable to overfishing and environmental disturbance, <a href="https://academic.oup.com/conphys/article/3/1/cov009/2571230?login=true">including climate change</a>. Their exoskeleton allows them to be dried and preserved easily. Many cultures believe seahorses to hold medicinal properties, especially traditional Chinese medicine, in which their dried bodies are believed to cure or prevent skin infections, asthma, and impotence, despite no evidence to support these claims. At least 25 million are traded annually for Chinese medicine. Fisheries harvest them faster than they can replenish their populations, leading to alarming <a href="https://www.frontiersin.org/articles/10.3389/fmars.2021.692068/abstract">declines in seahorse numbers</a>.</p><img src="https://counter.theconversation.com/content/165650/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Tupper does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Fascinating facts about this unusual fish include that it doesn’t swim very well. A marine expert reveals why
Mark Tupper, Senior Lecturer, Marine Biology (Fisheries), University of Portsmouth
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/140506
2020-09-02T12:53:47Z
2020-09-02T12:53:47Z
This ancient Chinese anatomical atlas changes what we know about acupuncture and medical history
<figure><img src="https://images.theconversation.com/files/355813/original/file-20200901-16-1qexa6v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/acupuncture-needles-ancient-medicine-illustration-showing-635954000">Pixeljoy/Shutterstock.com</a></span></figcaption></figure><p>The accepted history of anatomy says that it was the ancient Greeks who mapped the human body for the first time. <a href="http://www.bbc.co.uk/history/historic_figures/galen.shtml">Galen</a>, the “Father of Anatomy”, worked on animals, and wrote anatomy textbooks that lasted for the next 1,500 years. Modern anatomy started in the Renaissance with Andreas Vesalius, who challenged what had been handed down from Galen. He worked from human beings, and wrote the seminal “<a href="https://www.bl.uk/collection-items/vesalius-anatomy">On the Fabric of the Human Body</a>”.</p>
<p>Scientists from ancient China are never mentioned in this history of anatomy. But <a href="https://doi.org/10.1002/ar.24503">our new paper</a> shows that the oldest surviving anatomical atlas actually comes from Han Dynasty China, and was written over 2,000 years ago. Our discovery changes both the history of medicine and our understanding of the basis for acupuncture – a key branch of Chinese medicine.</p>
<p>There is an ever increasing body of <a href="https://www.nccih.nih.gov/health/acupuncture-in-depth">evidence-based research</a> that supports the efficacy of acupuncture for conditions as varied as migraine to osteoarthritis of the knee. The most recent <a href="https://www.nice.org.uk/guidance/gid-ng10069/documents/draft-guideline">draft NICE guidelines</a>, published in August 2020, recommend the use of acupuncture as a first line treatment for chronic pain.</p>
<p>During an acupuncture treatment session, fine needles are inserted into the body at specific points (acupoints) in order to promote self healing. This happens because the needles (somehow) create balance in the life force or “<em>Qi</em>” of the person. How this happens is the subject of much research. The underlying assumption is that acupoints have some as yet undiscovered physiological property that is probably neurologically based.</p>
<h2>Ancient Chinese texts</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chinese characters on a brown manuscript." src="https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1325&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1325&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1325&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1664&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1664&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1664&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Mawangdui Manuscript, ink on silk, 2nd century BCE.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Mawangdui_LaoTsu_Ms2.JPG">© Hunan Province Museum</a></span>
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<p>The texts we worked on are the <a href="http://www.hnmuseum.com/en/content/changsha-mawangdui-han-dynasty-tombs-exhibition">Mawangdui medical manuscripts</a>, which were lost to us for two millenia. They were written during the Han dynasty and were so valued that a copy was buried with the body of Lady Dai, a Han dynasty aristocrat in 168 BCE. The tombs of Lady Dai and her family were opened in 1973, and the Mawangdui manuscripts were discovered. </p>
<p>They are clearly precursors to the famous acupuncture texts of the Yellow Emperor’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2287209/">Canon of Internal Medicine</a> (<em>Huangdi Neijing</em>), which was copied and recopied through history, and is revered in China as the source of acupuncture theory and practice. The descriptions of meridians and points found in it are still the basis of traditional Chinese medicine today.</p>
<p>The earlier Mawangdui texts don’t actually mention acupuncture points, and the descriptions they give of meridians are simpler and less complete. But some passages from them have clearly been directly copied into the Yellow Emperor’s Canon, all of which shows that these texts were written first. </p>
<figure class="align-left ">
<img alt="Man with meridians drawn on" src="https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=891&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=891&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=891&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1119&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1119&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1119&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Illustration of traditional Chinese medicine.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:ChineseMedecine.JPG">Wikimedia Commons</a></span>
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<p>Meridian pathways have always been interpreted as being based on esoteric ideas about the flow of vital energy “<em>Qi</em>” rather than as empirical descriptions of the body. But what the Mawangdui text describes is a set of meridians – pathways through the body. In later texts, these are usually illustrated pictorially as lines on the skin.</p>
<p>A meridian is described in terms of how it progresses through the body. The arm <em>tai yin</em> meridian, for instance, is described as starting in the centre of the palm, running along the forearm between the two bones, and so on. We wondered: what if these descriptions are not of an esoteric energy pathway, but of physical anatomical structures?</p>
<h2>Dissecting history</h2>
<p>To find out, we did detailed dissections of the human body, looking for pathways which ran through it along the routes described in the Mawangdui.</p>
<p>This is a very different view of the body than that of the Western scientist. In modern western medicine, the body is divided into systems that each have their own distinct function: like the nervous system or cardiovascular system.</p>
<p>That clearly wasn’t what the writers of the Mawangdui were doing. Their descriptions are more focused on how different structures interlink to create a flow through the body. They pay no attention to the specific function of the structures. We think this is because these scientists were making their observations of the human body for the first time, and purely described what they saw.</p>
<p>For our research, the anatomical substance of the work had to be unearthed by carefully replicating the authors’ scientific dissections. This was problematic. They had left us no pictures of what they were describing, so we had to reconstruct from their texts. Later Chinese anatomists, from the <a href="http://en.tcm-china.org/art/2012/12/18/art_3282_69184.html">Song dynasty</a>, did make pictures. These works were based on the recorded dissections of a criminal gang for whom dissection was a part of their punishment.</p>
<figure class="align-center ">
<img alt="White statue of a man with Chinese characters drawn on." src="https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=822&fit=crop&dpr=1 600w, https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=822&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=822&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1034&fit=crop&dpr=1 754w, https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1034&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1034&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">An ancient acupuncture statue.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/29792566@N08/5494900763/">Traditional and Modern Medicine/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Then there was the issue of translation: so much can get lost when we translate texts, especially ancient ones, and one of us (Vivien) spent huge amounts of time cross-checking and confirming translations of the meridian descriptions. Finally, we had to look at Han-era society and show that anatomical examination would fit in their cultural context.</p>
<p>What we found was very exciting. Each of the Mawangdui meridians mapped onto major structures of the human body. Some of these structures are visible only to anatomists through dissection, and cannot be seen in the living person. To return to arm <em>tai yin</em>, for instance, the pathway is described at the elbow as going “below the sinew to the bicep”. When we look at the dissected human elbow, there is a flat band of tissue called the bicipital aponeurosis, and the arteries and nerves of the arm pass underneath it. </p>
<p>We think this is what the ancient Chinese anatomists were describing. There is no way to know about these structures except by doing anatomy, or reading the work of someone who has.</p>
<h2>The implications</h2>
<p>We therefore believe that the Mawangdui manuscripts are the world’s oldest surviving anatomical atlas based on direct observation of the human body. The authors’ purpose presumably was to record the human body in detail. Anatomical examination of this kind would have been a rare privilege, available only to a select group of scientists favoured by the Emperor. It is likely that the purpose of the texts was expressly to pass this knowledge on to others. Physicians and students of medicine could use the texts to learn about anatomy, and engage in medical debate based on a sound knowledge of the human body.</p>
<p>This gives us new insights into the scientific prowess of Han dynasty China, which is famous for its <a href="https://www.history.com/news/han-dynasty-inventions">wealth of discoveries</a>. That Han scientists also did anatomy would make perfect sense, and adds richness to our understanding of their science. </p>
<p>Our work also has fundamental implications for acupuncture theory and so for modern research. The Yellow Emperor’s Canon quite clearly draws on and develops the content of the Mawangdui. If the Mawangdui is an anatomical atlas, it is highly likely that the <a href="https://pubmed.ncbi.nlm.nih.gov/26861920/?from_term=vivien+shaw&from_pos=1">succeeding texts</a> are grounded in anatomy too. </p>
<p>The research shines a light on the hitherto unrecognised contributions of Chinese anatomists, and repositions them at the centre of the field. This new information challenges the perceived esoteric nature of acupuncture, and roots it instead in anatomical science.</p><img src="https://counter.theconversation.com/content/140506/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
New research shows that the oldest surviving anatomical atlas comes from Han Dynasty China, and was written over 2,000 years ago.
Vivien Shaw, Lecturer in Anatomy, Bangor University
Isabelle Catherine Winder, Lecturer in Zoology, Bangor University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/114980
2019-05-30T19:50:13Z
2019-05-30T19:50:13Z
Traditional medicines must be integrated into health care for culturally diverse groups
<figure><img src="https://images.theconversation.com/files/276758/original/file-20190528-42588-uc0t6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Traditional Chinese herbal remedies are today used in many countries.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p><em>This article is the fifth part in a series, <a href="https://theconversation.com/au/topics/where-culture-meets-health-70226">Where culture meets health</a>.</em></p>
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<p>Many people seek <a href="https://www.racgp.org.au/afp/2017/may/patterns-of-complementary-and-alternative-medicine-use-and-health-literacy-in-general-practice-patients-in-urban-and-regional-australia/">complementary treatments</a> for various ailments. Perhaps herbal remedies to cure a cold, or acupuncture to ease lower back pain. </p>
<p>“Complementary medicine” refers to practices outside Western medicine, adopted from other cultures, and often used in high-income countries.</p>
<p>But “traditional medicine” covers a range of practices and therapies indigenous to their practising population. Based on historical and cultural foundations, it operates outside of mainstream health care. </p>
<p>So for example, traditional Chinese medicine is indigenous to the Chinese and is therefore classified as a traditional medicine. But when it’s used by non-Chinese ethnicities, we’d call it a complementary medicine.</p>
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Read more:
<a href="https://theconversation.com/nearly-1-in-4-of-us-arent-native-english-speakers-in-a-health-care-setting-interpreters-are-essential-115125">Nearly 1 in 4 of us aren't native English speakers. In a health-care setting, interpreters are essential</a>
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<p>While many people use complementary medicines, traditional medicines form a particularly important influence on the way migrants look after their health.</p>
<p>This can present a challenge in the delivery of Western medical care to diverse communities in their destination countries.</p>
<p>But even where there’s little consensus around their efficacy, as we strive to achieve better health outcomes for culturally and linguistically diverse people, we must recognise traditional and complementary medicines as an essential component of their health care.</p>
<h2>A holistic approach</h2>
<p>Traditional and complementary medicines <a href="https://link.springer.com/article/10.1007%2Fs10903-018-0832-4">used among culturally and linguistically diverse populations</a> include herbal medicine, acupuncture, massage, traditional Chinese medicine, yoga, ayurveda, homeopathy, and tai chi. Different modalities are favoured in different communities.</p>
<p>Ayurveda is more than 5,000 years old and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ayurveda">native to India</a>. It combines lifestyle, diet, exercise and predominantly plant products as treatment options. Translating to “life science”, it aims to cleanse a person of disease-causing substances and restore balance in the body. </p>
<p>Ayurvedic practitioners believe this approach is effective in managing a number of acute and chronic conditions including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718571/">diabetes</a>, <a href="http://www.plantsjournal.com/archives/2017/vol5issue1/PartA/4-6-26-508.pdf">cancer</a>, <a href="http://www.ayurvedjournal.com/JAHM_201843_03.pdf">anxiety</a> and <a href="https://www.researchgate.net/profile/Rajkala_Patil/publication/319037230_Management_of_Rheumatoid_Arthritis_through_Ayurveda/links/598c2890a6fdcc58acb737ec/Management-of-Rheumatoid-Arthritis-through-Ayurveda.pdf">rheumatoid arthritis</a>.</p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/does-traditional-chinese-medicine-have-a-place-in-the-health-system-6166">Does traditional Chinese medicine have a place in the health system?</a>
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<p>While some studies point to its efficacy – one found ayurvedic formulations <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Ayurvedic+medicine+offers+a+good+alternative+to+glucosamine">were comparable to conventional medicines</a> such as glucosamine to treat knee osteoarthritis – varied results and limited study designs make it difficult to draw firm conclusions.</p>
<p>Meanwhile, traditional Chinese medicine has evolved since it was first used more than 2,000 years ago. But it remains grounded in its aim to treat the whole body, rather than targeting the problem alone.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Traditional remedies often accompany migrants to their destination countries.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>Encompassing practices including tai chi, acupuncture, and a variety of herbal remedies, Chinese medicine is today used to prevent and treat many conditions.</p>
<p>Patients with <a href="https://www.ncbi.nlm.nih.gov/pubmed/19877092">knee osteoarthritis</a> who practised tai chi recorded significant improvements, while there have been positive results for acupuncture in relieving <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/413107">lower back pain</a> and nausea associated with chemotherapy. </p>
<p>Traditional Chinese medicine has also been used for the prevention of <a href="http://www.onlinejacc.org/content/69/24/2952?_ga=2.21281211.1216051978.1500588607-1243537711.1500588607&sso=1&sso_redirect_count=2&access_token=">heart disease and stroke</a>, and to improve quality of life for people with <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/227164">chronic heart failure</a>.</p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/28619197">recent review</a> found certain Chinese medicines may control some risk factors for heart disease, like diabetes and high blood pressure. But several studies were limited by small sample sizes and flawed research designs.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/do-you-know-whats-in-the-herbal-medicine-youre-taking-72726">Do you know what's in the herbal medicine you're taking?</a>
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<p>Herbal remedies from Chinese medicine and beyond are employed to treat a range of conditions. St John’s wort has been used <a href="https://www.ncbi.nlm.nih.gov/pubmed/18843608">to treat mild depression</a>, Ginkgo Biloba for memory loss, and ginseng for musculoskeletal conditions. </p>
<p>Despite <a href="https://www.ncbi.nlm.nih.gov/pubmed/18843608">some promising results</a>, a substantial gap still exists between the strength of evidence supporting many of these practices and consumers’ use and acceptance of traditional and complementary medicines.</p>
<h2>If the evidence is limited, why should we pay attention?</h2>
<p>Some migrant communities experience poorer health than their host populations. For example, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-252">the rates of type 2 diabetes</a> are higher among migrants than in the wider Australian population.</p>
<p>It’s important to recognise that for minority groups, feeling as though a doctor doesn’t understand their cultural needs can be a barrier to help-seeking.</p>
<p>For instance, if a person doesn’t believe their doctor will approve of their use of traditional medicines, they may not disclose it. We know <a href="https://link.springer.com/article/10.1007%2Fs10903-018-0832-4">non-disclosure</a> of traditional and complementary medicine use is common among culturally diverse groups.</p>
<p>This can be dangerous, as some traditional and complementary medicines can <a href="https://europepmc.org/abstract/med/28762712">negatively interact</a> with other drugs.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/going-to-the-naturopath-or-a-yoga-class-your-private-health-wont-cover-it-110699">Going to the naturopath or a yoga class? Your private health won't cover it</a>
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<p>Where patients feel their practitioners are non-judgemental or even accepting of their traditional medicine use, they are <a href="https://www.ncbi.nlm.nih.gov/pubmed/19273869?dopt=Abstract">more likely to disclose it</a>.</p>
<p>So medical providers may benefit from education around different types of traditional and complementary medicines, including culturally sensitive methods to enquire about their use.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Acupuncture, a popular complementary therapy, has its roots in Chinese medicine.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<h2>What does Australia need to do?</h2>
<p>The most mature integrative health care systems are evident in Asia. Countries like South Korea and India <a href="https://www.bmj.com/content/322/7279/164.extract">have regulated</a> traditional and complementary medicines into their national health policies.</p>
<p>To effectively tackle health inequities, our health systems need to consider and address the impact of cultural influences on patients’ health-care decisions. This is vital even when the treatments they value may not be grounded in evidence.</p>
<p>Investigating and considering these practices will ultimately help us to design and facilitate safe, effective, culturally sensitive and coordinated care for all patients and communities across Australia.</p>
<p><em>Professor Jon Adams contributed to this article.</em></p><img src="https://counter.theconversation.com/content/114980/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Josephine Agu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
From herbal remedies to acupuncture, traditional therapies are valued particularly by ethnically diverse groups.
Josephine Agu, PhD candidate, University of Technology Sydney
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/107371
2018-11-23T10:24:09Z
2018-11-23T10:24:09Z
Captive breeding has a dark side – as disturbing Czech discovery of trafficked tiger body parts highlights
<figure><img src="https://images.theconversation.com/files/246828/original/file-20181122-182037-g6tveo.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Handout Czech Customs Authority</span></span></figcaption></figure><p>The <a href="https://www.theguardian.com/environment/2018/nov/19/gruesome-discovery-of-czech-tiger-farm-exposes-illegal-trade-in-heart-of-europe?CMP=Share_iOSApp_Othe">rotting remains</a> of a number of tigers, lions and cougars were recently discovered in a raid on a house in Prague. This disturbing find was the culmination of a five-year investigation that revealed an illegal trade in exotic wildlife blooming in the heart of Europe.</p>
<p>Czech authorities managed to identify the main figures behind an international crime ring who had been processing and selling wild cat parts as traditional Chinese medicine. Claws, teeth, bones, skin and extracts from their bodies known as “tiger wine” or “broth” were smuggled to Asia or used to supply the domestic demand in tiger products. The slaughtered tigers came from the country’s largest private breeding facility for lions and tigers – where, officially, these protected wildcats are bred for circuses, roadside attractions and petting zoos.</p>
<p>This story provides a stark reminder of the cruelty engendered by captive breeding. Even zoos heralded as the beacons of endangered species conservation play a controversial part in this story. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246829/original/file-20181122-182037-pykxvu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246829/original/file-20181122-182037-pykxvu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246829/original/file-20181122-182037-pykxvu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246829/original/file-20181122-182037-pykxvu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246829/original/file-20181122-182037-pykxvu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246829/original/file-20181122-182037-pykxvu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246829/original/file-20181122-182037-pykxvu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A bath in the house raided by Czech authorities.</span>
<span class="attribution"><span class="source">Handout Czech Customs Authority</span></span>
</figcaption>
</figure>
<h2>Captive tigers</h2>
<p>With only <a href="https://www.nytimes.com/2016/04/12/world/asia/wild-tiger-numbers-are-rising-wildlife-groups-say.html">3,900</a> left in the wild, the tiger family (<em>Panthera tigris</em>) is the only big cat listed as <a href="https://www.iucn.org/resources/conservation-tools/iucn-red-list-threatened-species">endangered</a>, with two subspecies critically endangered. The captive population, meanwhile, is abundant. </p>
<p>In 2014, the <a href="https://www.worldwildlife.org/stories/more-tigers-in-american-backyards-than-in-the-wild">WWF</a> alerted us to the alarming news that there are “more tigers living in American backyards than in the wild”. The organisation called on the US government to introduce a ban on private ownership of big cats. No such federal bill has been passed since, but <a href="https://bigcatrescue.org/state-laws-exotic-cats/">21 states</a> ban all dangerous exotic pets, while the rest allow certain species or require permits. Out of 5,000 captive tigers in the US alone, only 350 are held in zoos and other facilities accredited by the Association of Zoos and Aquariums. The <a href="http://www.stolenwildlife.org/druhy.html">estimated</a> number of tigers in the Czech Republic, meanwhile, is 390, only 39 of which are kept in zoos. </p>
<p>A growing number of cities around the world close their gates for <a href="https://bigcatrescue.org/big-cat-bans-enacted/">circuses</a> that use wild animals. According to <a href="http://www.eurogroupforanimals.org/wp-content/uploads/Eurogroup-for-Animals-Exotic-Pet-Report-FINAL.pdf">Czech law</a>, captive breeding of big cats requires special permits, while the environmental inspectorate records each tiger’s birth, sale or death. Following the discovery of the tiger slaughterhouse in Prague, the European Association of Zoos and Aquariums issued a <a href="https://www.eaza.net/assets/Uploads/EAZA-Documents-Other/2018-EAZA-Position-Statement-on-tiger-trade.pdf">statement</a> urging authorities to take immediate action in ensuring that all captive tigers serve noncommercial purposes such as research, education and conservation breeding.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246830/original/file-20181122-182071-vlbfr5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246830/original/file-20181122-182071-vlbfr5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246830/original/file-20181122-182071-vlbfr5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246830/original/file-20181122-182071-vlbfr5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246830/original/file-20181122-182071-vlbfr5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246830/original/file-20181122-182071-vlbfr5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246830/original/file-20181122-182071-vlbfr5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bones discovered by Czech authorities.</span>
<span class="attribution"><span class="source">Handout Czech Customs Authority</span></span>
</figcaption>
</figure>
<h2>Regal wildcats</h2>
<p>The idea of protecting endangered species through captive breeding in zoos is relatively new, but has a much longer and darker history. </p>
<p>Exotic animals first entered private collections in Europe as diplomatic gifts. Tigers were particularly highly priced in royal and aristocratic menageries as dangerous predators were seen to embody the political and physical prowess of their owners. Wild cats were also exhibited for popular audiences in circuses and other travelling shows. The intensive traffic in wildlife was largely facilitated by colonial expansion. That is why European port cities, as the centres for colonial commerce, were the first to open public zoos.</p>
<p>In the aftermath of decolonisation and the introduction of the <a href="https://www.cites.org/">Convention on International Trade in Endangered Species</a> in 1973, the lucrative business of capturing and trading exotic animals came to an end. Faced with the termination of a supply of specimens caught in the wild, zoological parks resorted to captive breeding. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246843/original/file-20181122-182065-c1rpfl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246843/original/file-20181122-182065-c1rpfl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246843/original/file-20181122-182065-c1rpfl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246843/original/file-20181122-182065-c1rpfl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246843/original/file-20181122-182065-c1rpfl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246843/original/file-20181122-182065-c1rpfl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246843/original/file-20181122-182065-c1rpfl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hunting for tigers, Thomas Williamson & Samuel Howitt, 1808.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Tiger_hunting#/media/File:ElephantbackTigerHunt.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>They did so, on the one hand to ensure they retained rare species in their collections and, on the other hand, to redirect their mission: from entertainment towards conservation. Devising so-called “Species Survival Plans”, accredited zoos have collaborated since 1981 to breed endangered species and manage all captive individuals of every species as one population to ensure genetic diversity. </p>
<p>But even after this period, research, education and conservation did not always drive captive breeding in zoos. Even non-commercial breeding does not always prioritise animal welfare. </p>
<h2>White tigers</h2>
<p>Many zoos, for example, are still devoted to breeding white tigers. Only two years ago the Czech <a href="https://www.zooliberec.cz/tygr-indicky-bila-forma.html">Liberec Zoo</a> celebrated the birth of two white cubs, that were transferred to Pont-Scorff Zoo in France in July this year. This rare variation of the Bengal tiger has distinctive white fur colouring with pale chocolate stripes and mesmerising blue eyes. The extraordinary coating results from a genetic mutation, which as a recessive trait is expressed only if both parents carry the mutation.</p>
<p>This inclined the zoos to practice inbreeding, often pairing off siblings in hope for a white-furred offspring. All 250 white tigers in captivity today <a href="https://zoostoriesblog.wordpress.com/2017/12/18/the-dynasty-of-enchanters-white-tigers-in-captivity/">are related</a>, having a common ancestor captured in 1951 – the wild-caught cub named Mohan that was the pride of Maharaja of Rewa, an Indian royalty who was determined to breed these rare wild cats. After several failed attempts, in 1957 the first white cubs were born in India from the union of Mohan and his daughter Radha. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246842/original/file-20181122-182047-1kgqd2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246842/original/file-20181122-182047-1kgqd2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246842/original/file-20181122-182047-1kgqd2d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246842/original/file-20181122-182047-1kgqd2d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246842/original/file-20181122-182047-1kgqd2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246842/original/file-20181122-182047-1kgqd2d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246842/original/file-20181122-182047-1kgqd2d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Captive tigers in the Czech Republic.</span>
<span class="attribution"><span class="source">Handout Czech Customs Authority</span></span>
</figcaption>
</figure>
<p>In 1960, the <a href="https://siarchives.si.edu/blog/where-have-all-white-tigers-gone">Smithsonian Institution</a> procured one of the female cubs for $10,000. Today she would be worth eight times more. While the royal ancestry of this exotic feline vividly stimulated the imagination of American zoogoers, her main task at the National Zoo was to produce more offspring of her kind. The demand for these extremely rare animals often justifies pairing off closely related tigers, even though inbred animals are prone to acquiring crippling defects including shortened legs, kidney problems and crossed eyes, as well as psychological issues. </p>
<h2>Tinder tigers</h2>
<p>The tigers slaughtered in the Czech Republic were not bred in zoos but in a private facility, yet their story should put captive breeding in general into question. </p>
<p>Today, tigers are bred outside of their natural habitats for a variety of reasons: for zoos, exhibitions, circuses performances or as pets. Tiger cubs are often displayed in petting zoos and subjected to the cruel practice of declawing. Adult tigers are drugged to pose in photos. People still see these extremely dangerous carnivores as proxies for luxury and sexiness.</p>
<p>But hopefully attitudes are changing. In 2017, <a href="https://blog.gotinder.com/take-down-the-tiger-selfies/">Tinder</a> launched a campaign to encourage its users to stop posting “tiger selfies”. And most recently, due to public pressure, China was <a href="https://www.bbc.com/news/world-asia-china-46190599">forced to reinstate</a> a <a href="http://english.gov.cn/policies/latest_releases/2018/10/29/content_281476367121088.htm">newly lifted ban</a> on using tiger bone and rhino horn in medicine.</p>
<p>Of course we need to pay attention to the conservation of today’s wild tigers threatened by habitat loss due to human activity, poaching, loss of prey and the swelling human-wildlife conflicts. But more attention should be paid to the plight of the enormous captive population of tigers across the world.</p>
<p><em>This article was updated on November 26 to correct the stated number of captive tigers in the US.</em></p><img src="https://counter.theconversation.com/content/107371/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marianna Szczygielska does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The slaughtered tigers were not bred in zoos, yet their story should put captive breeding in general into question.
Marianna Szczygielska, Postdoctoral Fellow, Max Planck Institute for the History of Science
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/106770
2018-11-22T02:34:11Z
2018-11-22T02:34:11Z
China’s legalisation of rhino horn trade: disaster or opportunity?
<p>The Chinese government will be <a href="http://www.gov.cn/zhengce/content/2018-10/29/content_5335423.htm?gs_ws=weixin_636764306700860312&from=singlemessage&isappinstalled=0">reopening</a> the nation’s domestic rhino horn trade, overturning a ban that has stood since 1993. An outcry since the announcement has led to the <a href="https://www.bbc.com/news/world-asia-china-46190599">postponement</a> of the lifting of the ban, which currently remains in place.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-case-for-introducing-rhinos-to-australia-99585">The case for introducing rhinos to Australia</a>
</strong>
</em>
</p>
<hr>
<p>The directive, if instituted, would require that rhino horn be sourced sustainably from farmed animals and that its use is limited to traditional Chinese medicine, scientific and medical research, preserving antique cultural artefacts, and as educational materials. </p>
<p>The announcement has been widely condemned. The <a href="https://www.unenvironment.org/news-and-stories/statement/official-statement-reversal-ban-trade-rhino-and-tiger-parts-china">United Nations Environmental Program</a> called it “alarming”. But <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cobi.12412">done carefully and correctly, and with necessary international consultation</a>, it doesn’t have to add to the threat to rhinos. Indeed, it could even support rhino conservation. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/245217/original/file-20181113-194488-11f6a0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/245217/original/file-20181113-194488-11f6a0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/245217/original/file-20181113-194488-11f6a0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/245217/original/file-20181113-194488-11f6a0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/245217/original/file-20181113-194488-11f6a0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/245217/original/file-20181113-194488-11f6a0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/245217/original/file-20181113-194488-11f6a0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/245217/original/file-20181113-194488-11f6a0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A legal trade of rhino horns, as seen here, could ensure income goes to legitimate conservation efforts as opposed to criminals.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rhinoceros-horn-sold-on-black-market-184131656?src=cOr4yKOQsYD6GDCFHzat9w-1-2">Paul Fleet/Shutterstock</a></span>
</figcaption>
</figure>
<p>Rhino horns regrow and can be sustainably and humanely <a href="https://www.environment.gov.za/sites/default/files/docs/studyon_dehorning_african_rhinoceros.pdf">harvested from live animals</a>. Those arguing for legalisation say that a <a href="http://science.sciencemag.org/content/339/6123/1038">well-regulated trade</a> could be a source of funding for expensive rhino conservation. It could also help reduce poverty and support development around protected areas. </p>
<p>A legal trade could also provide an alternative supply of horns, where income goes to legitimate conservation and development efforts, rather than to criminals, which is <a href="https://cites.org/sites/default/files/eng/cop/17/InfDocs/E-CoP17-Inf-17.pdf">currently the case</a>.</p>
<h2>Rhino horn for medicinal use</h2>
<p>The directive from Beijing stipulates that rhino horn for medicinal use must come from rhinos bred specifically outside of zoos (such as at dedicated horn-farming facilities). The ground-up horn powder would then be certified under a scheme developed by a coalition of Chinese regulatory agencies.</p>
<p>These agencies should draw from China’s experience regulating the medicinal use of pangolin scales to make sure poached horn does not infiltrate the legal marketplace. Though strictly controlled since 2008, <a href="https://www.traffic.org/site/assets/files/10569/pangolin-trade-in-china.pdf">illegal pangolin products</a> continue to be seized <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/conl.12339">frequently throughout China</a>. </p>
<p>According to the directive, the medicinal use of rhino horn will be restricted to treating urgent, serious and rare diseases. This is consistent with what traditional Chinese medicine practitioners see as the <a href="https://journals.sagepub.com/doi/full/10.1177/1940082918787428">appropriate application of rhino horn</a>. Strict guides for clinical application will be needed to prevent misuse and overuse, particularly given the length of time that rhino horn has been unavailable to law-abiding clinicians. </p>
<h2>Existing rhino horn stocks</h2>
<p>Beyond medicine, the directive stipulates that people who already own horns will be able to declare their stocks. The government will then issue identification and certification records. After this, the horns must be sealed and stored safely, and not traded under any circumstances, barring gift-giving and inheritance.</p>
<p>This part of the directive is particularly concerning, as such a scheme will be complex, potentially giving owners of poached rhino horns smuggled into China a get-out-of-jail-free card. Lessons should be learned from the ivory trade in Hong Kong, where poached ivory has been <a href="https://www.worldwildlife.org/publications/the-hard-truth-a-report-on-how-hong-kong-s-ivory-trade-is-fueling-the-african-elephant-poaching-crisis">laundered into legal stocks</a> thanks to inadequate record-keeping and lax enforcement.</p>
<p>This section of the directive also raises concerns about the development of a socially accepted practice of gifting rhino horn akin to <a href="https://www.tandfonline.com/doi/abs/10.1080/10871209.2018.1449038?journalCode=uhdw20">that of Vietnam</a>. There, rhino horn has been found to be given as a gift for terminally ill family members and in business settings, where horns are offered as bribes to government officials. Strict enforcement will essential if China is to make sure illegal trading under the guise of gifts is not to spread.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/245213/original/file-20181113-194500-f8mect.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/245213/original/file-20181113-194500-f8mect.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/245213/original/file-20181113-194500-f8mect.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/245213/original/file-20181113-194500-f8mect.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/245213/original/file-20181113-194500-f8mect.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/245213/original/file-20181113-194500-f8mect.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/245213/original/file-20181113-194500-f8mect.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/245213/original/file-20181113-194500-f8mect.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">China will have to work with countries where the rhinos live in Asia and Africa.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/bomeKKwqOgU">Kevin Folk/Unsplash</a></span>
</figcaption>
</figure>
<h2>Working with China</h2>
<p>China will have to work with countries where rhinos live, including range states in both Asia and in Africa, as well as other rhino conservation stakeholders around the world. <a href="https://cites.org/sites/default/files/eng/cop/17/prop/060216/E-CoP17-Prop-07.pdf">Swaziland</a> and <a href="https://www.cites.org/sites/default/files/eng/cop/10/prop/E-CoP10-P-28.pdf">South Africa</a> have previously proposed legalising the international trade in horn as a mechanism to fund and bolster conservation efforts.</p>
<p>Domestic trade in horn is legal in South Africa, and China and South Africa will have to coordinate to make sure their domestic marketplaces support rhino conservation and don’t enable transnational laundering and trade.</p>
<p>Beijing’s decision has certainly attracted immediate and fierce criticism from some <a href="https://www.worldwildlife.org/press-releases/wwf-statement-on-china-s-legalization-of-domestic-trade-in-tiger-bone-and-rhino-horn">conservation</a> and <a href="http://www.hsi.org/news/press_releases/2018/10/humane-society-international-102918.html">animal welfare</a> organisations. This criticism is exacerbated by <a href="http://science.sciencemag.org/content/358/6369/1378">different moral perspectives</a>. Some people see the sale and consumption of rhino horn to fund conservation as morally repulsive. For others, it is legitimate and pragmatic. </p>
<p>Whichever side of the debate you stand on, the priority should be conservation outcomes and making sure that China’s newly legalised domestic horn trade strengthens rather than dangerously undermines rhino protection efforts. Rhino conservationists will need to find common ground with Beijing. This requires an appreciation of different cultural and moral values, and the use of evidence on how to minimise risks to rhino under the directive.</p>
<p>Responding to the widespread criticism, Chinese officials <a href="http://www.china.org.cn/china/Off_the_Wire/2018-11/12/content_71941870.htm">clarified</a> that the implementation of the directive will be postponed. The government has also <a href="http://www.forestry.gov.cn/main/195/20181114/095004769532225.html">launched</a> a short-term enforcement drive against illegal trading of rhino horn, which will run until the end of the year.</p>
<p>While heightened enforcement actions are welcome, it indicates that China can do much more to tackle illegal wildlife trade. China must strictly enforce its own regulations once its domestic horn trade has been opened.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-northern-white-rhino-should-not-be-brought-back-to-life-94153">The northern white rhino should not be brought back to life</a>
</strong>
</em>
</p>
<hr>
<p>Postponing implementation gives Beijing time to develop a detailed and robust set of regulations. Now is the time for rhino range states, conservation scientists and concerned groups around the world to work with Beijing so that the impending domestic horn trade in China can be a positive for rhino conservation.</p><img src="https://counter.theconversation.com/content/106770/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hubert Cheung receives funding from the Lee Shau Kee Foundation.</span></em></p><p class="fine-print"><em><span>Duan Biggs receives funding from Australian Research Council.
Member of IUCN Sustainable Use and Livelihoods Group and World Commission for Protected Areas</span></em></p><p class="fine-print"><em><span>Yifu Wang is affiliated with TRAFFIC as a part time consultant. </span></em></p>
Trading rhino horn has been legalised in a bid to undercut poachers and the black market.
Hubert Cheung, PhD Candidate in Conservation Biology, The University of Queensland
Duan Biggs, Senior Research Fellow Social-Ecological Systems & Resilience, Griffith University
Yifu Wang, PhD Candidate, Department of Geography, University of Cambridge
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/105209
2018-10-18T19:14:29Z
2018-10-18T19:14:29Z
With the right help, bears can recover from the torture of bile farming
<p>Bear bile farms, which exist in some Asian countries like <a href="https://www.animalsasia.org/intl/media/news/news-archive/five-things-you-need-to-know-about-bear-bile-farming.html">Vietnam</a> and <a href="https://www.animalsasia.org/intl/media/news/news-archive/five-things-you-need-to-know-about-bear-bile-farming.html">China</a>, are a terrible reality for Asiatic black bears (<em>Ursus thibetanus</em>). </p>
<p>The bears spend their lives confined in tiny steel or concrete cages. They are “<a href="https://www.animalsasia.org/au/our-work/end-bear-bile-farming/what-is-bear-bile-farming/overview.html">milked</a>” through permanent holes in their side that allow bile to be extracted from the gall bladder. </p>
<p>My research, published in the journal <a href="http://www.ingentaconnect.com/contentone/ufaw/aw/2018/00000027/00000004/art00001">Animal Welfare</a>, investigated the chronic stress created by these conditions. We found that with care and rehabilitation, rescued bears in animal sanctuaries can readjust to a normal lifestyle with a reduction in stress – a highly encouraging result.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hugs-drugs-and-choices-helping-traumatised-animals-80962">Hugs, drugs and choices: helping traumatised animals</a>
</strong>
</em>
</p>
<hr>
<h2>What’s so precious about bile?</h2>
<p><a href="https://en.wikipedia.org/wiki/Bile">Bile</a> is a greenish-brown fluid produced by the liver in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091928/">humans</a> and <a href="https://medium.com/concepts-of-zoology-the-paradigm-shift-group/why-some-animals-dont-have-any-gallbladder-fe53cc44ee83">most vertebrates</a>. Bile acid aids digestion of fats – and one particular bile compound, called <a href="https://www.ncbi.nlm.nih.gov/pubmed/20609543">ursodeoxycholic acid</a>, could have potential <a href="https://www.medicines.org.uk/emc/product/7253/smpc">pharmaceutical applications</a>. </p>
<p>Because of this, bear bile is highly sought in <a href="http://www.onegreenplanet.org/animalsandnature/animal-products-health-benefits-driving-species-to-extinction/">traditional Chinese medicine</a>. It is believed to reduce gall stones and improve indigestion, among other things. However, non-animal-derived and synthetic alternatives exist for <a href="https://www.ncbi.nlm.nih.gov/pubmed/20609543">urosodeoxycholic acid</a> and other bile components.</p>
<p>The use of Asiatic black bears as primary sources of bile is a significant animal welfare problem that needs global awareness. Most of the bears are introduced to the trade upon poaching from the wild, and cubs as young as a few months are caged and <a href="https://www.animalsasia.org/intl/media/news/news-archive/five-things-you-need-to-know-about-bear-bile-farming.html">held captive</a> for up to 30 years. </p>
<p>I worked with the international welfare organisation <a href="https://www.animalsasia.org/au/our-work/bear-sanctuaries/">AnimalsAsia</a>, which runs <a href="https://www.animalsasia.org/au/about-us/vision-and-values.html">rescue and rehabilitation programs</a> in Asia and has moved hundreds of bears into sanctuaries.</p>
<p>My research investigated how successful this rehabilitation is, and whether rescued bears can recover from their experiences. </p>
<h2>Animal cruelty causes chronic stress</h2>
<p>Stress is <a href="https://www.lifeline.org.au/static/uploads/files/what-is-stress-wfvgiurqqawx.pdf">defined</a> as any unpleasant physical or psychological change that creates an uncomfortable feeling and negative outcome.</p>
<p>Not surprisingly, bears at bile farms in Vietnam have significantly higher levels of stress hormones than bears living in sanctuaries. This is the first scientific evidence of the chronic stress created by bear bile farming.</p>
<p>Stress in vertebrates (like humans and bears) is a physiological response in the endocrine system, also known as the <a href="https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis">hypothalamus-pituitary adrenal</a> axis. This is the body’s main control centre for all things related to stress.</p>
<p>Stress hormones like cortisol help regulate the metabolism, especially in times of short-term or acute stress such as “<a href="https://en.wikipedia.org/wiki/Fight-or-flight_response">fight or flight</a>” situations. In normal situations, sharp stress causes an increase of cortisol that allows an animal to react quickly to a dangerous situation. Once the danger passes, a <a href="https://courses.washington.edu/conj/bess/feedback/newfeedback.html">negative feedback loop</a> reduces <a href="http://www.yourhormones.info/hormones/cortisol/">cortisol</a> production and keeps the body stable.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/stress-is-bad-for-your-body-but-how-studying-piglets-may-shed-light-97650">Stress is bad for your body, but how? Studying piglets may shed light</a>
</strong>
</em>
</p>
<hr>
<p>But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/">chronic stress</a> can lead to harmful changes in the stress endocrine system. Long-term cortisol overproduction weakens the body’s ability to fend off daily challenges, and increases the risk of disease and death. In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/">humans</a>, chronic stress contributes to problems with the cardiovascular, immune and central nervous systems. </p>
<p>The presence of what we call “<a href="https://www.foodanimalbiosciences.org/uploads/2/4/2/6/24266896/non-domestic_felids.pdf">stress biomarkers</a>” in <a href="https://research-repository.griffith.edu.au/bitstream/handle/10072/54397/89070_1.pdf;sequence=1">faeces</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3624789/">hair</a> can be a very useful tool for assessing animal welfare. </p>
<p>We measured cortisol levels in bear faeces to rapidly and reliably check their <a href="https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11285&catId=33178&id=3976383&ind=14&objTypeID=17&print=1">stress levels</a>. </p>
<p>This was particularly useful because we did not have to restrain the rescued bears, a process that would understandably upset them more than their peers.</p>
<h2>Reversing chronic stress in bear sanctuaries</h2>
<p>Chronic stress is a massive challenge for the successful rehabilitation of animals into their new environment. Careful monitoring of stress is essential in animal rescue and <a href="https://www.ncbi.nlm.nih.gov/pubmed/12462487">translocation programs</a> because it can provide information on the physiological resilience of each animal, and help rescuers understand how the animals might respond to humane interventions and veterinary checks. </p>
<p>Rescued bears are given special veterinary care and integrated into the bear sanctuary after several months of careful physiological and behavioural assessments. </p>
<p>Our <a href="http://www.ingentaconnect.com/contentone/ufaw/aw/2018/00000027/00000004/art00001">data</a> show that although not all bears fully recover from living on a bile farm, they generally manage to reduce their stress hormone levels under the <a href="http://www.ingentaconnect.com/contentone/ufaw/aw/2018/00000027/00000004/art00001">rehabilitation program</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-dogs-life-studying-stressed-humans-can-help-us-keep-animals-happy-59486">A dog's life: studying stressed humans can help us keep animals happy</a>
</strong>
</em>
</p>
<hr>
<p>Like humans, animals need <a href="https://www.everydayhealth.com/healthy-living/love-reduces-stress.aspx">love and care</a>. <a href="https://www.westernsydney.edu.au/newscentre/news_centre/more_news_stories/stress_test_how_scientists_can_measure_how_animals_are_feeling">Stress reseach</a> has shown humane treatment can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260341/">reverse chronic stress</a> – and our study has found that is true even for animals who have experienced intolerable treatment.</p><img src="https://counter.theconversation.com/content/105209/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edward Narayan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Bears in Asia are trapped in bile farms, where they are kept in small cages for decades.
Edward Narayan, Senior Lecturer in Animal Science; Stress and Animal Welfare Biologist, Western Sydney University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/80896
2017-07-20T20:10:01Z
2017-07-20T20:10:01Z
New complementary medicine health claims lack evidence, so why are they even on the table?
<figure><img src="https://images.theconversation.com/files/178771/original/file-20170719-13534-1g6r575.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Australian drugs regulator is overhauling the health claims made by suppliers of complementary medicines, including homeopathic therapies. And some curious options are up for discussion.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/557763373?src=IytjhciZWcCOoNS_bLGpyw-1-61&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Australia’s drugs regulator seems to be endorsing pseudoscientific claims about homeopathy and traditional Chinese medicine as part of its <a href="https://theconversation.com/which-supplements-work-new-labels-may-help-separate-the-wheat-from-the-chaff-73189">review</a> of how complementary medicines are regulated.</p>
<p>In the latest proposed changes, the Therapeutic Goods Administration (TGA) is looking at what suppliers (also known as sponsors) can claim their products do, known as “<a href="http://www.tga.gov.au/draft-list-permitted-indications">permitted indications</a>”. An example of a “low level” permitted indication might be “may relieve the pain of mild osteoarthritis”.</p>
<p>If approved, the suppliers can use this permitted indication to market its listed product, one of about 11,000 listed complementary medicines on the <a href="https://www.tga.gov.au/australian-register-therapeutic-goods">Australian Register of Therapeutic Goods</a> (indicated by “Aust L” on packaging).</p>
<p>However, the spreadsheet of <a href="http://www.tga.gov.au/sites/default/files/draft-list-permitted-indications.xlsx">1,345 draft permitted indications</a> includes many that seem to lack evidence to back them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=236&fit=crop&dpr=1 600w, https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=236&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=236&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=297&fit=crop&dpr=1 754w, https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=297&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/178602/original/file-20170718-22000-1r98mlz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=297&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Complementary medicines are the subject of the latest TGA review of permitted health claims.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>For instance, despite the Therapeutic Goods Advertising Complaints Resolution Panel upholding complaints of a lack of evidence that <a href="http://www.tgacrp.com.au/complaint-register/?_search=magnesium">magnesium</a> (and <a href="http://www.tgacrp.com.au/complaint-register/?_search=restless+legs&_id=3101">homeopathy</a>) “relieves muscle cramps (and restless legs)”, this permitted indication is on its draft list.</p>
<p>Other examples include “supports transport of oxygen in the body”, “regulates healthy male testosterone levels”.</p>
<p>The list contains around 140 traditional Chinese medicine indications, such as “Harmonise middle burner (Spleen and Stomach)”, “Unblock/open/relax meridians”, “Balance Yin and Yang”.</p>
<p>There are also around 900 additional indications for unspecified “traditions”. These include, “Renal tonic”, “Helps healthy liver regeneration”, “Emmenagogue”, “Vermifuge” and “Vulnerary”.</p>
<h2>Endorsing traditional medicines without evidence they work</h2>
<p>Australia is a multicultural society, and it’s appropriate we <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam001_complementary_medicine_resource_clinicians_140409.pdf">respect and have some knowledge</a> of complementary medical traditions.</p>
<p>Some observations made in these traditions have led to valuable, efficacious medicines, such as <a href="https://theconversation.com/is-the-2015-nobel-prize-a-turning-point-for-traditional-chinese-medicine-48643">Artemisinin derivatives</a> isolated from a herb used in traditional Chinese medicine.</p>
<p>However, scientific investigation has not substantiated many other aspects of such traditions, such as the <a href="https://theconversation.com/no-evidence-homeopathy-is-effective-nhmrc-review-25368">homeopathic principles</a> of “like cures like” and <a href="https://theconversation.com/are-traditional-chinese-medicines-safe-and-legal-6373">traditional Chinese medicine</a> concepts of meridians through which the life-energy known as “qi” flows.</p>
<p>We also cannot assume traditional medicines are safe, as <a href="https://www.ncbi.nlm.nih.gov/pubmed/22374080">emerging data</a> highlights how common adverse reactions and drug interactions really are.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/178194/original/file-20170714-14315-3dbel0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Just because complementary medicines are based on long-held traditions doesn’t mean they work or are safe, as international data show.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>For example, Hyland’s homeopathic baby teething products were recalled by the <a href="https://www.fda.gov/safety/recalls/ucm552934.htm">US Food and Drug Administration</a> and then <a href="https://www.tga.gov.au/alert/hylands-baby-homeopathic-teething-tablets">the TGA</a>. This was because lack of quality control over potentially toxic ingredients – belladonna alkaloids – associated with <a href="https://www.scientificamerican.com/article/hundreds-of-babies-harmed-by-homeopathic-remedies-families-say/">adverse events in hundreds of babies</a>. </p>
<p>In China, out of the 1.33 million case reports of adverse drug event reports received by the National Adverse Drug Reaction Monitoring Center in 2014, <a href="http://www.sda.gov.cn/WS01/CL0078/124407.html">traditional Chinese medicine represented around 17.3%</a> (equivalent to around 230,000 cases).</p>
<h2>What we propose</h2>
<p>Listed medicines, like those mentioned, are meant to contain pre-approved, relatively low-risk ingredients. They should be produced with good manufacturing practice and only make “low-level” health claims for which evidence is held. However, the TGA does not check these requirements before the product is marketed.</p>
<p>So, to safeguard shoppers, consumer representatives (of which I was one), suggested the proposed list of permitted indications should be short and only contain modest claims such as, “may assist” or “may help”.</p>
<p>We also argued that, for consumers to make an informed purchase, claims based on “traditional use” should always have a disclaimer along the lines of what the <a href="https://www.ftc.gov/system/files/documents/federal_register_notices/2016/12/homeopathic_drugs_frn_12-13-2016.pdf">US Federal Trade Commission uses for homeopathic products</a>. </p>
<p>For example, “This product’s traditional claims are based on alternative health practices that are not accepted by most modern medical experts. There is no good scientific evidence that this product works”.</p>
<p>However, industry representatives <a href="http://www.asmi.com.au/media/30081/asmi_response_to_cm_de-regulation_review__april_2015_.pdf">argued</a> they needed a long list of permitted indications to allow consumers to tell the difference between one product and another. They also argued that disclaimers for traditional medicines were unnecessary. Their wishes made it to the draft list, rather than ours.</p>
<p>While we welcome moves to <a href="https://theconversation.com/which-supplements-work-new-labels-may-help-separate-the-wheat-from-the-chaff-73189">better regulate</a> complementary medicines in Australia, this current list of permitted indications, without disclaimers, represents a government endorsement of pseudoscience.</p>
<p>Worse, it will encourage consumers to purchase often ineffective and sometimes dangerous products.</p><img src="https://counter.theconversation.com/content/80896/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ken Harvey has represented Choice (the Australian Consumers’ Association) on TGA consultations about regulatory reform of complementary medicines. He is also an executive member of Friends of Science in Medicine and a member of the Australian Skeptics Victorian Branch.</span></em></p>
Would you trust a complementary medicine described as “vermifuge”, “vulnerary” or “emmenagogue”? That’s what new labelling proposes and not everyone’s happy about it.
Ken Harvey, Associate Professor, School of Public Health and Preventive Medicine, Monash University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/79430
2017-06-19T01:04:46Z
2017-06-19T01:04:46Z
Emergency doctors are using acupuncture to treat pain, now here’s the evidence
<figure><img src="https://images.theconversation.com/files/174109/original/file-20170616-519-1v70ply.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Doctors with special training in acupuncture and practitioners of traditional Chinese medicine worked together in emergency departments.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/467699921?src=UHqdQ2DUj9poIUxTG_8Haw-1-36&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Emergency medicine is not all about life and death situations and high-tech solutions. Our study, the largest of its kind in the world, shows using acupuncture in the emergency department can relieve acute pain.</p>
<p>The study, published today in the <a href="https://www.mja.com.au/journal/2017/206/11/acupuncture-analgesia-emergency-department-multicentre-randomised-equivalence">Medical Journal of Australia</a>, finds acupuncture is as effective as medication in treating pain for lower back pain and ankle sprain. But it took more than an hour for either to provide adequate pain relief.</p>
<p>Our study builds on previous research to show the effectiveness of acupuncture to treat <a href="http://www.bmj.com/content/338/bmj.a3115">chronic</a> (long-term) <a href="https://www.ncbi.nlm.nih.gov/pubmed/20070551">pain</a>.</p>
<p>Yet, there are several barriers to using acupuncture routinely in emergency departments.</p>
<h2>What is acupuncture and who practices it?</h2>
<p>Using acupuncture to relieve pain involves placing needles in various parts of the body to stimulate the release of endorphins and other neurochemicals, which can act as the body’s naturally occurring pain relievers.</p>
<p>For generations <a href="https://theconversation.com/modern-acupuncture-panacea-or-placebo-8102?sa=google&sq=acupuncture&sr=1">various cultures</a> around the world have used acupuncture to treat multiple conditions, including providing pain relief. And in Australia, it is reimbursed through the <a href="http://www9.health.gov.au/mbs/search.cfm?q=173-195&sopt=I">Medicare Benefits Schedule</a> when administered by a medical doctor.</p>
<hr>
<p><em>Further reading: <a href="https://theconversation.com/modern-acupuncture-panacea-or-placebo-8102?sa=google&sq=acupuncture&sr=1">Modern acupuncture: panacea or placebo?</a></em></p>
<hr>
<p>Acupuncture is one of the <a href="http://online.liebertpub.com/doi/abs/10.1089/acm.2005.11.995">most accepted</a> forms of complementary medicine among Australian general practitioners. It also appears in treatment guidelines for doctors in <a href="https://tgldcdp.tg.org.au/guideLine?guidelinePage=Analgesic&frompage=etgcomplete">how to manage</a> pain. </p>
<h2>Why we ran the study and what we did</h2>
<p>Anecdotally, we were aware that several emergency department doctors, in both public and private hospitals in Australia, were treating patients’ pain with acupuncture. But until this large federally-funded study, no-one had set up a trial like it to show how effective it was.</p>
<p>Our trial was an “equivalence” study, which means we aimed to see if the different treatments were equivalent rather than seeing if they were better than <a href="https://theconversation.com/explainer-what-is-the-placebo-effect-and-are-doctors-allowed-to-prescribe-them-55219?sa=google&sq=placebo&sr=1">placebo</a>. We did this as it would not be ethical to give a placebo to people coming to an emergency department for pain relief.</p>
<p>So, we randomly assigned more than 500 patients to receive standard painkillers, standard painkillers plus acupuncture, or acupuncture alone when they presented with back pain, migraine or ankle sprain at four Melbourne hospitals (some private, some public). While the patients knew which treatment they had, the researchers involved in assessing their pain didn’t (known as a single-blind study).</p>
<p>The type of acupuncture we used included applying needles at specific points on the body for each condition, as well as along points chosen by the treating acupuncturist. This was to reflect what would happen during regular clinical practice.</p>
<p>Doctors who were also qualified medical acupuncturists and practitioners of traditional Chinese medicine (registered in Victoria with the <a href="http://www.chinesemedicineboard.gov.au/">Chinese Medicine Registration Board of Australia</a>) performed the acupuncture.</p>
<p>After treatment, we assessed patients’ pain after an hour, and every hour until discharge. We also rang them for an update 24-48 hours after being discharged.</p>
<h2>What we found</h2>
<p>We found acupuncture, either alone or with painkillers, was equivalent to drugs-alone in providing pain relief for lower back pain, ankle sprain, but not for migraine.</p>
<p>When patients looked back on their treatment, the vast majority (around 80%) were satisfied with their treatment regardless of which treatment they had.</p>
<p>However, no treatment provided good pain relief until after the first hour.</p>
<h2>What are the implications?</h2>
<p>Our findings suggest acupuncture may be a viable option for patients who come to the emergency department for pain relief. This is especially important for those who cannot or choose not to have analgesic drugs. </p>
<p>This is also an important finding in light of the potential for side effects and abuse with opioid analgesics, which might otherwise be used to relieve pain in the emergency department.</p>
<p><a href="http://www.iama.edu/OtherArticles/acupuncture_WHO_full_report.pdf">Previous research</a> shows using acupuncture to treat chronic pain is comparable to morphine, is safer and doesn’t lead to dependence. Our findings suggest acupuncture also has a role in treating acute pain.</p>
<p>However, our research raises several issues, not only about conducting such research but also in implementing our findings in practice.</p>
<p>We had to overcome many ethical, policy and regulatory issues before we started. These included issues around the qualifications of medical and non-medical acupuncturists and employing traditional Chinese medicine practitioners to deliver acupuncture in a western medical hospital.</p>
<p>And to more widely implement our findings, we need to discuss the type of practitioners best placed to deliver acupuncture in hospital, what type of training they need to work in the emergency department and what type of conditions they should treat.</p>
<p>Hopefully, our study will spark further research to address these issues and lead to the development of safe and effective protocols for acute pain relief that may involve combining both modern and ancient forms of medicine to achieve rapid and effective analgesia for all emergency department patients.</p><img src="https://counter.theconversation.com/content/79430/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marc Cohen received funding from the NHMRC. </span></em></p>
Some emergency doctors are already using acupuncture to relieve patients’ pain. Now a new study shows when it works, when it doesn’t and how emergency departments of the future might use it.
Marc Cohen, Professor of Health Sciences, RMIT University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/78558
2017-06-05T06:47:04Z
2017-06-05T06:47:04Z
‘Himalayan Viagra’ is threatened by fervent Chinese demand and climate change
<figure><img src="https://images.theconversation.com/files/171653/original/file-20170531-1275-1afeha4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's not too late to get your Himalayan Viagra, but it'll cost you.</span> <span class="attribution"><a class="source" href="http://maxpixel.freegreatpicture.com/static/photo/1x/Scenery-Himalayas-Romantic-Nepal-Lake-2145071.jpg">Max Pixel </a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>At the beginning of the Himalayan summer, when the snows start to melt, all the schools close for the season and Nepali parents and children move to the grasslands with enough food for a month-long journey on a quest for a herb more valuable than gold. </p>
<p>To find <em><a href="http://thediplomat.com/2014/08/yarsagumba-biological-gold/">yarsagumba</a></em>, families crawl through muddy fields hoping to spot a yellowish-green mummified caterpillar that resembles a disproportionate unicorn, with a dark-coloured elongated fungus growing out of a larva’s head. </p>
<p>In Chinese, the two-faced creature is called <em>dong chong xia cao</em>, which translates as “winter worm, summer grass”. During the winter, <em>yarsagumba</em> is worm-like, but by the summer, invaded by fungus, it looks more like a plant. </p>
<p>Mature <em>yarsagumba</em> resembles nothing so much as a matchstick, thin and slender, projecting two to three centimetres above the ground across the alpine meadows of the Himalayas. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/171588/original/file-20170531-25691-sok3e3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171588/original/file-20170531-25691-sok3e3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171588/original/file-20170531-25691-sok3e3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171588/original/file-20170531-25691-sok3e3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171588/original/file-20170531-25691-sok3e3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171588/original/file-20170531-25691-sok3e3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171588/original/file-20170531-25691-sok3e3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">(A) The stroma and sclerotium sections; (B, C) The complex of mycelial cortices and attached soil particles outside the sclerotium as indicated by arrows.</span>
<span class="attribution"><span class="source">Zhang et al, 2010</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Himalayan viagra</h2>
<p>To locals, the hunt is well worth it. Just one kilogram of <em>yarsagumba</em> can <a href="https://thehimalayantimes.com/business/yarsagumba-lifts-living-standard-of-rural-nepalis/">fetch up to US$100,000</a>. In rural Nepal, where <a href="http://www.ilo.org/wcmsp5/groups/public/---asia/---ro-bangkok/---ilo-kathmandu/documents/publication/wcms_543497.pdf">jobs are limited</a>, the majority of families living at high altitudes as well as those in neighbouring regions earn their living by collecting this herb, making it by far the most <a href="https://doi.pangaea.de/10.1594/PANGAEA.833518">valuable commodity around</a>.</p>
<p>Bu why is it so lucrative? The name is a hint: <em>yarsagumba</em> is also known as “Himalayan Viagra” due to the aphrodisiac medley of caterpillar and fungus. </p>
<p>It is believed that cattlemen first discovered the pharmacological benefits of the caterpillar-fungus more than a thousand years ago after noticing their yaks becoming energised from feeding on the herb. </p>
<p>Starting in the 1960s, people have been making tea and soups out of this mythological little plant-animal, and stuffing the belly of a duck with <em>yarsagumba</em> herbs before roasting.</p>
<p>This magic fungus was widely popularised in the 1990s, when a <a href="http://www.telegraph.co.uk/athletics/2016/02/25/athletics-world-records-blow-as-wang-junxia-admits-being-part-of/">Chinese runner</a> who ate it broke <a href="http://mushroaming.com/blogs/cordyceps?page=2">two world records</a>. Since then, research on the caterpillar-fungus has intensified.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/171580/original/file-20170531-25664-tgynyd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171580/original/file-20170531-25664-tgynyd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=808&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171580/original/file-20170531-25664-tgynyd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=808&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171580/original/file-20170531-25664-tgynyd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=808&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171580/original/file-20170531-25664-tgynyd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1016&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171580/original/file-20170531-25664-tgynyd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1016&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171580/original/file-20170531-25664-tgynyd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1016&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A market selling ‘Himalayan Viagra’ in Bhutan, and a close up of this complex chimera.</span>
</figcaption>
</figure>
<p>The main <a href="https://www.researchgate.net/publication/233417214_Chemical_Constituents_of_Yarsagumba_Ophiocordyceps_sinensis_Berk_Sung_et_al_a_Valued_Traditional_Himalayan_Medicine">chemical constituents</a> of natural Cordyceps’s 28 saturated and unsaturated fatty acids are palmitic acid, linoleic acid, oleic acid, stearic acid, and ergo sterol. It also includes vitamins and inorganic elements. </p>
<p>Chinese medicine now <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121254/">asserts that</a> that <em>yarsagumba</em> can cure impotence, increase libido, and resolve joint pains, as well as treat cancer and obesity. </p>
<p>Some of these claims have been substantiated. According to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791983/#ref99">2016 paper</a> in the journal Pharmacognosy Review, the authors found evidence “illustrating that <em>O. sinensis</em> can enhance libido and sexual performance, and can restore impaired reproductive functions, such as impotency or infertility, in both sexes.”</p>
<h2>Fungus through the looking glass</h2>
<p>As Lewis Carroll writes in his book <a href="https://www.gutenberg.org/files/12/12-h/12-h.htm">Through the Looking Glass</a>, “It takes all the running you can do, to stay in the same place”. That seems the perfect metaphor for the <em>yarsagumba</em>, a living relationship in which a host and a parasite are involved in a continuous arms race. </p>
<p>Biologically speaking, this complex chimera consists of ghost moth larvae (the <em>Thitarodes</em> species in caterpillar stage) infected by the parasitic entomogenous ascomycete, <em>Ophiocordyceps sinensis</em>. </p>
<p>Ghost moths are relatively large moths known for their reduced adult mouth parts and distinctive subterranean larvae, which are root-feeders of grassland soil, meaning they can feed on any parts of a plant.</p>
<p>The caterpillars spend several years of their lives remaining dormant in winter, and emerge as adults after pupating in early summer. Then, alas, they die; the average adult lifespan of <em>Thitarodes</em> is two to five days. </p>
<p><em>Thitarodes</em> are the only hosts to the <em>O. sinensis</em> parasite, and young caterpillars infected by the fungal spores perish before pupation, a wildly growing mycelium having consumed the body of the larva. </p>
<p>After two to four weeks, a slender, sprouting body emerges from behind the head of the larva. It is an eerie death, to be sure. </p>
<p>Scientists don’t entirely understand this spectacular co-evolutionary process. Because the fungus is highly host-specific and it is very difficult to rear moths in laboratories, its infection pathway is still under investigation. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/171587/original/file-20170531-25664-1xyljut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171587/original/file-20170531-25664-1xyljut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=477&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171587/original/file-20170531-25664-1xyljut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=477&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171587/original/file-20170531-25664-1xyljut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=477&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171587/original/file-20170531-25664-1xyljut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=600&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171587/original/file-20170531-25664-1xyljut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=600&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171587/original/file-20170531-25664-1xyljut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=600&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">(A) Male adult moth; (B) Female adult moth; (C) Late-instar larva; (D) Pupa.</span>
<span class="attribution"><span class="source">Cannon et al., 2009</span></span>
</figcaption>
</figure>
<h2>Humans: the final threat</h2>
<p>In this biotrophic system in which the parasite must kill its host to survive, humans may be considered a third trophic level: we parasitise this parasitic complex. </p>
<p>As the medicinal value of <em>yarsagumba</em> is increasingly hyped, China’s massive consumer market is clamouring for the product, causing its price to rise and spurring a veritable gold rush to Nepal’s Himalayan belt. </p>
<p>But collecting these fungi before they mature prevents dispersal of their spores, and the availability of <em>yarsagumba</em> is declining yearly. From a 2009 peak to 2011, the <a href="http://www.nature.com/news/overharvesting-leaves-himalayan-viagra-fungus-feeling-short-1.12308">trade fell</a> by half per annum. Due to a lack of proper regulation, over-harvesting is increasingly common. </p>
<p>The fungi are also vulnerable to climate change. As global temperatures rise and <a href="http://www.navdanya.org/climate-change/in-the-himalayas">snowfall in the Himalayas decreases</a>, their natural habitat suffers, limiting the breeding period.</p>
<p>There is a darker side to the fungus fad, too. Every year, as families race to the hills for their annual <em>yarsagumba</em> quest, some fungus hunters – both adults and school children – <a href="http://www.bbc.com/news/world-south-asia-12110240">lose their lives</a> to turf wars and the precipitous, unforgiving mountains. </p>
<p>In June 2009, seven Nepalese men who had climbed up the mountains to pick <em>yarsagumba</em> were attacked with sticks and knives, and their bodies thrown into the deep ravines.</p>
<p>Local Buddhists, especially those of the older generation, believe that to pick <em>yarsagumba</em> <a href="http://www.bbc.com/news/world-south-asia-12110240">is a sin</a>, in keeping with the Buddha’s teaching that this seemingly natural treasure is actually a curse. China’s consumers don’t seem to mind.</p><img src="https://counter.theconversation.com/content/78558/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Prayan Pokharel does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The coveted and unusual aphrodisiac found only at very high altitudes can fetch up to US$100,000 a kilo.
Prayan Pokharel, Doctoral Student in Institute for Insect Biotechnology, University of Giessen
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/52144
2015-12-10T20:09:27Z
2015-12-10T20:09:27Z
What’s in your herbal medicines?
<figure><img src="https://images.theconversation.com/files/105183/original/image-20151210-7428-j8b0yp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The most concerning finding was leopard DNA.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-72466159/stock-photo-traditional-chinese-medicine-herbs-and-remedies-in-jars.html?src=HIr8BTFSvoXmoCsud7eENg-1-14">Elena Elisseeva/Shutterstock</a></span></figcaption></figure><p>by Ian Musgrave and <a href="https://theconversation.com/profiles/michael-bunce-8333">Michael Bunce</a></p>
<p>Many people take herbal medicines, including traditional Chinese medicine (TCM) thinking they are doing something positive for their health. Ironically, in many cases they may be doing just the opposite.</p>
<p>Have you ever wondered what is actually in the herbal medicine products you buy? Has the herb on the label been replaced with another herb? Have pharmaceuticals been snuck in? </p>
<p>Making sure that a tablet claiming to have 500 milligrams of paracetamol really does contain 500 milligrams of paracetamol is relatively easy, there are established assays to measure paracetamol routinely. But how do you test for herbs? </p>
<p>Most herbal medicines are pills or powders that have removed all trace of structure we would normally use to identify plants, and many plants have no chemical signature that is able to definitively identify them. And what about all the other possible contaminants and adulterants that could hide in the complex brew of chemicals from herbal medicines?</p>
<p><a href="http://www.nature.com/articles/srep17475">Our research</a>, which has just been published in the journal <a href="http://www.nature.com/srep/">Nature Scientific Reports</a>, goes a long way to answering that.</p>
<p>For the first time, our group of researchers from <a href="http://www.curtin.edu.au/">Curtin University</a>, <a href="http://www.murdoch.edu.au/">Murdoch University</a> and the <a href="http://www.adelaide.edu.au/">University of Adelaide</a> have combined some of the most cutting-edge and sensitive analytical techniques to screen a set of traditional Chinese medicines available in Australia. </p>
<p>We used a three-pronged approach, combining DNA sequencing, toxicology and heavy metal testing to elucidate the true composition of 26 TCMs purchased at random from the Adelaide Markets; most were either for colds and flu’s or for general wellness. </p>
<h2>What did we find?</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/105221/original/image-20151210-7442-7b1atq.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/105221/original/image-20151210-7442-7b1atq.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/105221/original/image-20151210-7442-7b1atq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=544&fit=crop&dpr=1 600w, https://images.theconversation.com/files/105221/original/image-20151210-7442-7b1atq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=544&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/105221/original/image-20151210-7442-7b1atq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=544&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/105221/original/image-20151210-7442-7b1atq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=684&fit=crop&dpr=1 754w, https://images.theconversation.com/files/105221/original/image-20151210-7442-7b1atq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=684&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/105221/original/image-20151210-7442-7b1atq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=684&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Summary of the contaminants in traditional Chinese medicines (TCMs) tested in this study that contained toxic metals, undeclared or illegal contents as determined by DNA, toxicological, and heavy metal screening methods. Each TCM tested is represented in the diagram as a tablet; blue shading on tablets indicate AUST L listed medicines, red shading are not-listed with the TGA regulatory body. TCMs deemed non-compliant.
for DNA (green), toxicology (pink) and heavy metals (yellow) or a combination thereof, are represented within the Venn diagram.</span>
<span class="attribution"><span class="source">Coglan et al.,Sci Reports 2015</span></span>
</figcaption>
</figure>
<p>Nearly nine in ten of these medicines had some form of undeclared substance in them as either adulteration or contamination. Sixteen of TCM’s had more than one contaminant or adulterant. </p>
<p>While around half of these medicines were not listed with the <a href="http://www.tga.gov.au/index.htm">Therapeutic Goods Administration</a> (TGA), and should not have been available for purchase, contaminants were found in both TGA-listed and non-listed medicines. These adulterants/contaminants included pharmaceuticals and toxic heavy metals. </p>
<p>Plant and/or animal DNA from species not listed on the labels were also found. The most concerning finding was snow leopard DNA (snow leopards are an endangered species), which was detected in one medicine. DNA from pit viper, frog, rat, cat and dog was also detected in several medicines. </p>
<p>Among the pharmaceuticals found were paracetamol, antihistamines, anti-inflammatories and antibiotics, and stimulants such as pseudoephedrine. Of particular concern were drugs such as warfarin, which have significant potential for harm if not taken under medical supervision, and ephedrine, which is banned in Australia.</p>
<p>Significant levels of toxic heavy metals such as arsenic, cadmium and lead were found in over half the medicines. In at least four of these medicines following the directions on the label would expose you to over ten times the TGA’s regulatory limit for heavy metals in medicines.</p>
<h2>What does this mean?</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/105222/original/image-20151210-7431-1oi14lx.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/105222/original/image-20151210-7431-1oi14lx.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=513&fit=crop&dpr=1 600w, https://images.theconversation.com/files/105222/original/image-20151210-7431-1oi14lx.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=513&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/105222/original/image-20151210-7431-1oi14lx.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=513&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/105222/original/image-20151210-7431-1oi14lx.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=645&fit=crop&dpr=1 754w, https://images.theconversation.com/files/105222/original/image-20151210-7431-1oi14lx.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=645&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/105222/original/image-20151210-7431-1oi14lx.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=645&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Herbal Medicines.</span>
<span class="attribution"><span class="source">Megan Coglan</span></span>
</figcaption>
</figure>
<p>Are the levels of undeclared materials in these products adulteration or contamination? In <em>adulteration</em>, the material is added deliberately. In <em>contamination</em>, the material is added inadvertently, for example, through unclean workplaces or herbs grown on contaminated soil. </p>
<p>Whether a compound is a result of deliberate adulteration or contamination has different regulatory implications. It can mean the difference between banning a substance or cleaning up the workplace. </p>
<p>It can be tricky to decide which is which. In TCM materials, for instance, <a href="http://www.cnbc.com/id/100992436">heavy metals</a> or <a href="http://www.ncbi.nlm.nih.gov/pubmed/12866383">toad venom</a> may be added as part of the treatment. However, by looking at the patterns of materials we found, we can get some hints. </p>
<p>One TCM claiming to enhance weight gain with appetite stimulation contained pharmaceutically relevant levels of the drug <a href="https://en.wikipedia.org/wiki/Cyproheptadine">cyproheptadine</a>, a known appetite enhancer. </p>
<p>In another, <a href="https://en.wikipedia.org/wiki/Ephedrine">ephedrine</a> was found without any evidence of DNA from plants of the <a href="https://en.wikipedia.org/wiki/Ephedra_sinica">Ephedra</a> genus, suggesting that in both cases the drug was deliberately added. </p>
<p>Intriguingly, high levels of arsenic were often found with similar levels of lead. <a href="https://www.lead.org.au/lanv10n3/lanv10n3-7.html">Lead arsenate</a> has been used as a pesticide, and the high levels may come from persistently contaminated soils.</p>
<p>What this means is that you should be very careful about choosing and purchasing TCMs. Definitely avoid any medicine that does not have an <a href="https://www.ebs.tga.gov.au/">ARTG listing</a> (it should have a number like AUST L 123456 on the front of the bottle). But even medicines with these AUST L labels are no guarantee of safety.</p>
<p>This also highlights the importance of informing your health practitioner if you are taking TCMs as adulterants might interact with conventional medication to cause adverse effects. </p>
<h2>What are the regulatory implications?</h2>
<p>Unlike countries such as the United States, where many herbal medicines are regulated as dietary supplements, in Australia, herbal medicines are regulated through the TGA as medicines.</p>
<p>TGA-regulated medicines can be approved as either <a href="https://www.tga.gov.au/registered-and-listed-medicines">“registered” or “listed”</a>. Most herbal medicines are classified as <a href="https://www.tga.gov.au/listed-medicines">“listed”</a>. Unlike registered medicines such as paracetamol and <a href="http://www.nps.org.au/medicines/heart-blood-and-blood-vessels/anti-clotting-medicines/for-individuals/anticoagulant-medicines/for-individuals/active-ingredients/warfarin">warfarin</a>, the evidence required for approval is much less stringent. </p>
<p>In many ways it is an honour system, where the herbal medicines sponsor says there’s no evidence of harm, and they hold documentation that shows this. Mostly, the evidence is historical, claiming that people have been using it for generations without evidence of harm. As well, if the compounds are on the TGA’s list of “generally recognised are safe” materials extensive safety testing is not required.</p>
<p>The TGA uses post marketing follow-up to check for compliance with the “listed” medicine regulations. This follow-up consists of <a href="http://www.anao.gov.au/Publications/Audit-Reports/2011-2012/Therapeutic-Goods-Regulation-Complementary-Medicines/Audit-brochure">random surveys as well as targeted surveys</a> from concerns raised by consumers. </p>
<p>In Australia, nearly 2,000 new herbal medicines are registered each year.
In a <a href="http://www.tga.gov.au/behind-news/complementary-medicines-compliance-reviews-2013">TGA survey in 2012-2013</a>, 145 complementary medicines were tested. Around 83% of complimentary medicines surveyed were deemed to be non-compliant, with 6% failing due to product composition, formulation or manufacturing.</p>
<p>Using a combination of new molecular approaches, our survey found a much higher level of adulteration and contamination in TCMs than found in the TGA’s surveys. Adding DNA ingredient screening to the TGA’s armoury of analytical methods would help ensure that undeclared ingredients are not included in the herbal medicines we consume. </p>
<h2>And Finally:</h2>
<p>The herbal medicine industry is a billion dollar international industry, with products travelling all over the world. </p>
<p>Globally, we need a better auditing “toolkit” to ensure consumers of herbal medicines, as well as people testing their efficacy, are not being misled. </p>
<p>This research, we think, provides a roadmap to more effective regulation of the herbal medicine sector. </p>
<p><em>* The results of our screening have been passed on to the TGA, which is following this up.</em></p><img src="https://counter.theconversation.com/content/52144/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Ian Musgrave and Michael Bunce receive funding from the National Health and Medical research Council to study adulteration and Contamination of herbal medicine. Ian Musgrave is a board member of the Australasian Society of Clinical and Experimental Pharmacology and Toxicoloy</span></em></p>
Making sure that a tablet claiming to have 500 mg of paracetamol really does contain 500 mg of paracetamol is relatively easy. But how do you test for herbs?
Ian Musgrave, Senior lecturer in Pharmacology, University of Adelaide
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/48645
2015-10-07T14:21:12Z
2015-10-07T14:21:12Z
How traditional Chinese medicine drove the discovery of a Nobel-winning anti-malarial drug
<figure><img src="https://images.theconversation.com/files/97601/original/image-20151007-7378-3y36av.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Harvesting Artemisia annua</span> <span class="attribution"><span class="source">Novartis AG/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Tu Youyou was tasked with finding a cure for malaria by Mao Zedong in 1969. More than four decades later, her discoveries help save more than 100,000 lives every year <a href="http://www.oxfordtoday.ox.ac.uk/interviews/nick-white">in Africa alone</a>, and she has been rewarded with the highest honour in medicine, the Nobel Prize, shared with fellow parasite-battling scientists <a href="https://theconversation.com/nobel-prize-for-medicine-goes-to-unsung-heroes-in-fight-against-parasites-and-malaria-48621">William C Campbell and Satoshi Ōmura</a>.</p>
<p>What might seem unusual about her scientific work is that Tu began by looking to the plants used in traditional Chinese medicine. But it is far from the only time a <a href="http://www.ncbi.nlm.nih.gov/pubmed/17201169">modern cure</a> has been found from traditional Chinese medicine and it is unlikely <a href="http://www.ncbi.nlm.nih.gov/pubmed/3059066">to be the last</a>.</p>
<p><a href="http://www.nature.com/nm/journal/v17/n10/full/nm.2471.html">Tu and her colleagues</a> searched ancient Chinese medical texts for references to herbs and recipes that might have been used to fight malaria-type symptoms such as fever, rigors and headache. They systematically screened the well-documented texts and sifted through more than 2,000 herb preparations of traditional Chinese herbs and from these identified 380 herb extracts and tested them on mice being infected by malaria parasites.</p>
<p>One of these, the common Chinese plant sweet wormwood (<em>Artemesia annua</em>) was prescribed in a 4th century Jin dynasty text, for treating fevers – a key malaria symptom. When tested, it was found to reduce the number of malaria parasites in the blood.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/97600/original/image-20151007-7371-1e2v343.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/97600/original/image-20151007-7371-1e2v343.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=598&fit=crop&dpr=1 600w, https://images.theconversation.com/files/97600/original/image-20151007-7371-1e2v343.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=598&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/97600/original/image-20151007-7371-1e2v343.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=598&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/97600/original/image-20151007-7371-1e2v343.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=751&fit=crop&dpr=1 754w, https://images.theconversation.com/files/97600/original/image-20151007-7371-1e2v343.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=751&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/97600/original/image-20151007-7371-1e2v343.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=751&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tu Youyou and her tutor in 1951.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Tu_Youyou_and_Lou_Zhicen_in_1951.TIF">Wenxue City/Wikimedia Commons</a></span>
</figcaption>
</figure>
<h2>Turning the plant into a drug</h2>
<p>Tu’s team then started to use different solvents to isolate different chemicals from sweet wormwood. They tested these chemicals one by one against mice infected by malaria parasites until they identified a compound that at a very low dose can kill the parasites faster than other anti-malarial drugs. This compound, artemisinin, can uniquely produce chemically reactive molecules in the parasite that kills them. </p>
<p>Isolating different classes of chemicals in plants requires strategy and patience. And producing a pure single compound such as artemisinin in a reasonable quantity from a plant with a higher potency than a synthetic drug is a major achievement. This is often done using a solvent to dissolve certain chemicals from plant material and then slowly evaporating the resulting solution to isolate the compounds. By repeating the process using different solvents it is possible to separate different chemicals. </p>
<p>But as well as following scientific methods to isolate the artemisinin, Tu again drew from Chinese medicine, a key element of which involves preparing plants in certain ways to affect their chemical properties. In line with this, Tu discovered that isolating the artemisinin from the plant was best performed at low temperatures. </p>
<h2>Impact on malaria</h2>
<p>The discovery of artemisinin has made a huge difference in the management of malaria treatment in the world. In 2013, <a href="http://who.int/malaria/media/artemisinin_resistance_qa/en/">392 million treatment courses</a> using the drug were procured by countries where the disease in endemic. If the malaria parasite were to become resistant to the drug it would severely hamper the goal of malaria eradication and also result in large increases in <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733336/">African childhood mortality</a>. </p>
<p>To prevent this from happening, <a href="http://www.ncbi.nlm.nih.gov/pubmed/16760509">doctors have tried</a> to limit the use of artemisinin-based compounds by combining them with other drugs that kill the parasites in a different way. Such <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2901398/">artemisinin based combination therapy</a> is recommended for treatment of uncomplicated malaria (which doesn’t severely affect the internal organs) caused by the parasite <em>Plasmodium falciparum</em>. Only severe malaria cases are given full doses of artemisinin derivatives (artesunate or artemether)</p>
<p>Despite the efforts to quickly diagnose and carefully treat malaria, there have been <a href="https://theconversation.com/parasite-resistance-imperils-our-last-effective-malaria-drug-21685">reports of resistance</a> to artemisinin derivatives <a href="https://theconversation.com/parasite-resistance-imperils-our-last-effective-malaria-drug-21685">on the Thai-Cambodian border</a>. In view of the potential resistance to artemisinin derivatives, perhaps a <a href="https://theconversation.com/is-the-2015-nobel-prize-a-turning-point-for-traditional-chinese-medicine-4864">traditional Chinese approach</a> of holistic treatment featuring a prescription of a combination of plants should be re-visited.</p><img src="https://counter.theconversation.com/content/48645/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Annie Bligh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Tu Youyou sifted through 2,000 ancient herbal remedies to develop a drug that now treats hundreds of millions of people a year.
Annie Bligh, Professor of Medicinal Plant Science, University of Westminster
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/48644
2015-10-06T13:19:15Z
2015-10-06T13:19:15Z
The secret Maoist Chinese operation that conquered malaria – and won a Nobel
<figure><img src="https://images.theconversation.com/files/97426/original/image-20151006-7366-lvxsbp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">1964 poster: 'Prevent Malaria and Take Care of People's Health.'</span> <span class="attribution"><a class="source" href="https://www.nlm.nih.gov/exhibition/chineseantimalaria/gallery.html">Painted by Wu Hao 吴昊</a></span></figcaption></figure><p>At the height of the Cultural Revolution, Project 523 – a covert operation launched by the Chinese government and headed by a young Chinese medical researcher by the name of Tu Youyou – discovered what has been the most powerful and effective antimalarial drug therapy to date. </p>
<p>Known in Chinese as qinghaosu and derived from the sweet wormwood (<em>Artemisia annua L.</em>), artemisinin was only one of several hundred substances Tu and her team of researchers culled from Chinese drugs and folk remedies and systematically tested in their search for a treatment to chloroquine-resistant malaria. </p>
<p>How Tu and her team discovered artemisinin tells us much about the <a href="http://dx.doi.org/10.1017/S0269889711000329">continual Chinese effort to negotiate</a> between traditional/modern and indigenous/foreign. </p>
<p>Indeed, contrary to popular assumptions that Maoist China was summarily against science and scientists, the Communist party-state needed the scientific elite for certain political and practical purposes. </p>
<p>Medicine, particularly when it also involved foreign relations, was one such area. In this case, it was the war in Vietnam and the scourge of malaria that led to the organization of Project 523. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/97412/original/image-20151006-7375-bhm608.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/97412/original/image-20151006-7375-bhm608.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/97412/original/image-20151006-7375-bhm608.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/97412/original/image-20151006-7375-bhm608.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/97412/original/image-20151006-7375-bhm608.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/97412/original/image-20151006-7375-bhm608.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=546&fit=crop&dpr=1 754w, https://images.theconversation.com/files/97412/original/image-20151006-7375-bhm608.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=546&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/97412/original/image-20151006-7375-bhm608.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=546&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">North Vietnamese soldiers had to deal with disease as well as the enemy.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/13476480@N07/6000193987">manhhai</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>A request from Vietnam and a military answer</h2>
<p>As fighting escalated between American and Vietnamese forces throughout the 1960s, malaria became the number one affliction compromising Vietnamese soldier health. The increasing number of chloroquine-resistant malaria cases in the civilian population further heightened North Vietnamese concern. </p>
<p>In 1964, the North Vietnamese government approached Chinese leader Mao Tse Tung and asked for Chinese assistance in combating malaria. Mao responded, “Solving your problem is the same as solving our own.”</p>
<p>From the beginning, Project 523, which was classified as a top-secret state mission, was under the direction of military authorities. Although civilian agencies were invited to collaborate in May 1967, military supervision highlighted the urgent nature of the research and protected it from adverse political winds. </p>
<p>The original three-year plan produced by the People’s Liberation Army Research Institute <a href="http://www.testsbpraauthorapps.com/bdbbldwebfly.php?isbn=9781622121649">aimed to</a> </p>
<blockquote>
<p>integrate far and near, integrate Chinese and Western medicines, take Chinese drugs as its priority, emphasize innovation, unify plans, divide labor to work together. </p>
</blockquote>
<h2>The medical mission</h2>
<p>Project 523 had three goals: the identification of new drug treatments for fighting chloroquine-resistant malaria, the development of long-term preventative measures against chloroquine-resistant malaria, and the development of mosquito repellents. </p>
<p>To achieve these ends, research on Chinese drugs and acupuncture was integral. </p>
<p>The decision to investigate Chinese drugs was not without precedent. Back in 1926, Chen Kehui and Carl Schmidt of the Peking Union Medical College published their <a href="http://dx.doi.org/10.1001/jama.1926.02680110036011">original paper on ephedrine</a>, derived from Chinese herb <em>mahuang</em>. It ignited a research fire in which more than 500 scientific papers on ephedrine (for relief for asthma) appeared around the world by 1929. </p>
<p>In the 1940s, state interest in the Chinese drug <a href="http://dx.doi.org/10.1177/030631299029003001">changshan and its antimalarial properties</a> led to the establishment of a state-funded research institute and experimental farm in Sichuan province.</p>
<p>Project 523’s embrace of Chinese <em>materia medica</em> – the traditional body of knowledge about substances’ healing properties – is a more recent example of the efforts to “scientize” Chinese medicine through selective appropriation and detailed investigation. </p>
<p>Biomedical interest in Chinese drugs was not in itself new. But the institutional climate within which Project 523 investigators worked was different from earlier antimalarial research efforts. The Vietnam War had exacerbated an epidemiological crisis to which Maoist China responded with nationalist fervor by turning to its institutions of traditional Chinese medicine.</p>
<p>In the 1960s, such institutions were a mixing ground of specialists, many of whom possessed more than a passing familiarity with Chinese medicine and biomedicine. This ensured that <a href="http://dx.doi.org/10.1111/j.1365-2125.2006.02673.x">qinghao research proceeded</a> within a climate in which scientists, “who themselves had learnt the ways of appreciating traditional knowledge, worked side by side with historians of traditional medicine, who had textual learning.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/97373/original/image-20151006-29239-8md0dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/97373/original/image-20151006-29239-8md0dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/97373/original/image-20151006-29239-8md0dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/97373/original/image-20151006-29239-8md0dg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/97373/original/image-20151006-29239-8md0dg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/97373/original/image-20151006-29239-8md0dg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/97373/original/image-20151006-29239-8md0dg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/97373/original/image-20151006-29239-8md0dg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tons of Artemisia annua are grown annually in China today.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/51868421@N04/8679796757">Novartis AG</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<h2>Tu Youyou’s story</h2>
<p>Tu Youyou’s research fits within this Maoist story of medical systematization and standardization. </p>
<p>Born in 1930, she was a medical student during the 1950s, when state efforts to make Chinese medicine scientific through the research and expertise of biomedical researchers were especially acute. She rose to the head of a malaria research group at the Beijing Academy of Traditional Chinese Medicine in 1969.</p>
<p>The <a href="http://dx.doi.org/10.1038/nm.2471">group was composed</a> of phytochemical researchers who studied the chemical compounds that occur naturally in plants and pharmacological researchers who focused on the science of drugs. They began with a list of over 2,000 Chinese herbal preparations, of which 640 preparations were found to have possible antimalarial activities. They worked steadily and obtained more than 380 extracts from some 200 Chinese herbs, which they then evaluated against a mouse model of malaria. </p>
<p>Of the 380+ extracts they had obtained, a qinghao (<em>Artemisia annua L.</em>) extract appeared promising, but inconsistently so. Faced with varying results, Tu and her team returned to the existing <em>materia medica</em> literature and reexamined each instance in which qinghao appeared in a traditional recipe.</p>
<p>Tu was drawn to one particular reference made by Ge Hong 葛洪 (284-363) in his fourth-century BC text, Emergency Prescriptions One Keeps Up One’s Sleeve. <a href="http://dx.doi.org/10.1016/j.trstmh.2005.09.020">Ge Hong instructed</a>:</p>
<blockquote>
<p>take a bunch of qing hao and two sheng [2 x 0.2 liter] of water for soaking it, wring it out to obtain the juice, and ingest it in its entirety.</p>
</blockquote>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/97408/original/image-20151006-7333-1k4ymc1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/97408/original/image-20151006-7333-1k4ymc1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/97408/original/image-20151006-7333-1k4ymc1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/97408/original/image-20151006-7333-1k4ymc1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/97408/original/image-20151006-7333-1k4ymc1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/97408/original/image-20151006-7333-1k4ymc1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/97408/original/image-20151006-7333-1k4ymc1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/97408/original/image-20151006-7333-1k4ymc1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Chinese woodcut portrait of Ge Hong.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Chinese_woodcut,_Famous_medical_figures;_Portrait_of_Ge_Hong_Wellcome_L0039323.jpg">Gan Bozong via Wellcome Images</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In what can be characterized as her eureka moment, <a href="http://dx.doi.org/10.1172/JCI60887">Tu had the idea</a> 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.” Her <a href="http://news.sinovision.net/portal.php?mod=view&aid=187091">hunch proved correct</a>; once they switched to a lower-temperature procedure, Tu and her team obtained much better and more consistent antimalarial activity with qinghao. By 1971, they had obtained a nontoxic and neutral extract that was called qinghaosu or artemisinin. It was 100% effective against malarial parasites in animal models. </p>
<p>Tu’s research has <a href="http://www.laskerfoundation.org/awards/2011_c_description.htm">drawn accolades</a> from the international scientific community, while also igniting a <a href="http://oversea.cnki.net.proxy.library.emory.edu/kcms/detail/detail.aspx?QueryID=7&CurRec=1&DbCode=CJFD&dbname=CJFDLAST2015&filename=KXYJ201506002">debate</a> in the Chinese language media about the celebration of individual inventors over collective group efforts.</p>
<p>This too, perhaps, may be part of the legacy of Maoist mass science, which demanded research that served practical needs and engaged the masses. Scientific achievement, while important, was not the be-all, end-all of scientific work. During the Cultural Revolution, it mattered that science proceed along revolutionary <a href="http://dx.doi.org/10.1086/521159">lines</a>. It mattered that scientific advances resulted from collective endeavor and drew from popular sources. Does it still?</p><img src="https://counter.theconversation.com/content/48644/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jia-Chen Fu does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The 2015 Nobel Prize for Medicine went partly for research done during the Chinese Cultural Revolution based on traditional Chinese medicine. Here’s the story of Project 523.
Jia-Chen Fu, Assistant Professor of Chinese, Emory University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/48643
2015-10-06T02:55:23Z
2015-10-06T02:55:23Z
Is the 2015 Nobel Prize a turning point for traditional Chinese medicine?
<figure><img src="https://images.theconversation.com/files/97345/original/image-20151006-29239-5kjtz5.jpg?ixlib=rb-1.1.0&rect=193%2C33%2C1213%2C888&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Never before has a Nobel gone to an expert in traditional Chinese medicine. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/bomb_bao/4595447563/in/photolist-815Ssx-7H8jY-bARAXX-b9r8ik-bCmTMC-4Vo4hD-6Y8Xr3-6Y8XS9-6Y4ULT-2HYkJr-nksZ3-pkAMwU-5ZpQdM-8vtC48-8vujZV-8vys7q-8vwL63-8vt5fr-8vvKTs-4VopR4-8195e1-QJUK3-cinNt-4EkpHq-8vsVTP-8vvDEE-8vsRwt-8vtsqD-8vw1P9-8vuq6B-8vxkDy-8vtJRX-8vwuqd-cbCtkw-4XwSGV-6Px7nw-4VgVqh-8vw4mN-8vwHnS-8vsCQR-8vugpH-8vw3w7-5Zq6jr-8vvoaR-8vuW9z-8vw5Kb-8vv6gX-4WxgLj-5Zv6iA-4VcunM">bomb_bao/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>I’m sure I’m not the only one surprised by the announcement that half of the <a href="http://www.nobelprize.org/nobel_prizes/medicine/laureates/2015/">2015 Nobel Prize in Physiology or Medicine</a> has gone to a researcher who spent her entire career researching traditional Chinese medicine. Based at the Chinese Academy of Traditional Chinese Medicine in Beijing (now the China Academy of Chinese Medical Sciences) since 1965, scientist Youyou Tu, her colleagues, and home institution may well be just as stunned today as I am.</p>
<p>Being granted the Lasker Award is often a good predictor of Nobel Prize prospects. Tu <a href="http://www.laskerfoundation.org/awards/2011_c_description.htm">received one in 2011</a> for her discovery of Artemisinin as an alternative malaria cure to the standard chloroquine, which was quickly losing ground in the 1960s due to increasingly drug-resistant parasites. Scientific research on the pharmaceutically active properties of traditional Chinese medicinals, however, has never been a predictor for such widespread international recognition.</p>
<p>Traditional medical knowledge anywhere in the world has not even been on the radar for Nobel Prize prospects. Until now, that is. So how should we interpret this arguably seismic shift in international attention on traditional Chinese medicine? </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/kxBe5t3V2e0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Watch the announcement of the winners and the following Q&A.</span></figcaption>
</figure>
<h2>Discoveries to be made in historical record</h2>
<p>In the question-and-answer session after the announcement at the Karolinska Institute, which awards the Nobels, one of the panelists emphasized not just the quality of Tu’s scientific research, but also the value of recorded empirical experience in the past. </p>
<p>The antifebrile effect of the Chinese herb <em>Artemisia annua</em> (qinghaosu 青蒿素), or sweet wormwood, was known 1,700 years ago, he noted. Tu was the first to extract the biologically active component of the herb – called Artemisinin – and clarify how it worked. The result was a paradigm shift in the medical field that allowed for Artemisinin to be both clinically studied and produced on a large scale.</p>
<p>Tu has always maintained that she drew her inspiration from the medical text of a fourth-century Chinese physician and alchemist named Ge Hong 葛洪 (circa 283-343). </p>
<p>His <a href="https://books.google.com/books?id=R3Sp6TfzhpIC&pg=PA1357&lpg=PA1357&dq=zhouhou+beijifang&source=bl&ots=491ajlT9eJ&sig=IGwvxAlm7zydwTKIk_NAmO3p-kE&hl=en&sa=X&ved=0CCwQ6AEwA2oVChMIzMfDvdisyAIVRB0-Ch2f6w1z#v=onepage&q=zhouhou%20beijifang&f=false">Emergency Formulas To Keep at Hand</a> (Zhouhou beijifang 肘後備急方) can best be understood as a practical handbook of drug formulas for emergencies. It was a book light enough to keep “behind the elbow” (zhouhou), namely, in one’s sleeve, where Chinese men sometimes carried their belongings. We can discern from Ge’s astute description of his patients’ symptoms that people then suffered not only from malaria but also from other deadly diseases including smallpox, typhoid and dysentery.</p>
<p>Beyond recording the fever-fighting qualities of <em>Artemisia annua</em>, Physician Ge also wrote about how <em>Ephedra sinica</em> (mahuang 麻黃) effectively treated respiratory problems and how arsenic sulphide (“red Realgar,” xionghuang 雄黃) helped control some dermatological problems. </p>
<h2>Traditional ingredients, modern drugs</h2>
<p>Just because a compound has natural roots and has long been used in traditional medicine is no reason to take it lightly. </p>
<p>You might remember that in 2004, the <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2004/ucm108242.htm">FDA actually banned</a> ephedra-containing dietary and performance-enhancing supplements. They’d been the cause not only of serious side effects but also several deaths. The ban remains in effect in the US despite a court challenge from <a href="https://en.wikipedia.org/wiki/Ephedra">ephedra manufacturers</a>. Related drug <a href="http://www.webmd.com/drugs/2/drug-8100/ephedrine-hcl-oral/details">ephedrine</a>, however, is used to treat low blood pressure and is a common ingredient in over-the-counter asthma medicines. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/97342/original/image-20151006-29262-1p35mkc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/97342/original/image-20151006-29262-1p35mkc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=446&fit=crop&dpr=1 600w, https://images.theconversation.com/files/97342/original/image-20151006-29262-1p35mkc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=446&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/97342/original/image-20151006-29262-1p35mkc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=446&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/97342/original/image-20151006-29262-1p35mkc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=560&fit=crop&dpr=1 754w, https://images.theconversation.com/files/97342/original/image-20151006-29262-1p35mkc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=560&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/97342/original/image-20151006-29262-1p35mkc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=560&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Compounds long known by practitioners of traditional Chinese medicine to be effective are being isolated now in modern labs.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/vkreay/153577630/in/photolist-ez8hb-4J4LyV-81944u-6uC1Mi-rSgLJG-7Pc1gd-815SNk-5pJEB-vf2Kk-veX2Q-PfzNx-7bbt8P-P8Qye-4RQHLU-HN9Fu-4wm4Zw-qU8FD-6FCZ1S-7oGXxq-cvcpHU-rZ5f5D-815Ssx-7H8jY-bARAXX-b9r8ik-bCmTMC-4Vo4hD-6Y8Xr3-6Y8XS9-6Y4ULT-2HYkJr-nksZ3-pkAMwU-5ZpQdM-8vtC48-8vujZV-8vys7q-8vwL63-8vt5fr-8vvKTs-4VopR4-8195e1-QJUK3-cinNt-4EkpHq-8vsVTP-8vvDEE-8vsRwt-8vtsqD-8vw1P9">vkreay/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>As for Realgar, its toxicity was well-known in both ancient Greece and <a href="http://www.amazon.fr/LAconit-lorpiment-Drogues-ancienne-m%C3%A9di%C3%A9vale/dp/2213598916">Chinese antiquity</a>. In Chinese medical thought, though, skillfully administered toxins may also be powerful antidotes for other toxins. Realgar thus <a href="https://www.eastlandpress.com/books/chinese_herbal_medicine_materia_medica_3rd_edition.php">continues to be used in Chinese medicine</a> as a drug that relieves toxicity and kills parasites. Applied topically, it treats scabies, ringworm and rashes on the skin’s surface; taken internally, it expels intestinal parasites, particularly roundworms. </p>
<p>Although biomedicine does not currently use Realgar or its related <a href="http://dx.doi.org/10.1124/jpet.108.139543">mineral arsenicals</a> in treatments, Chinese researchers have been studying their <a href="http://dx.doi.org/10.1016/j.jep.2011.03.071">anticancer properties</a> for some time now. In 2011, a Chinese researcher at Johns Hopkins University, Jun Liu (with other colleagues), also discovered that the Chinese medicinal plant Tripterygium wilfordii Hook F (lei gong teng 雷公藤 “Thunder God Vine”) is <a href="http://dx.doi.org/10.1038/nchembio.522">effective against cancer, arthritis and skin graft rejection</a>.</p>
<p>Tu’s groundbreaking work on artemisinin, in fact, can be seen as the tip of the iceberg of the extensive and global <a href="http://press.uchicago.edu/ucp/books/book/chicago/N/bo18610904.html">scientific study of pharmacologically active Chinese medicinals</a>, including another successful antimalarial <em>Dichroa febrifuga</em> (<a href="http://www.jstor.org/stable/285408">changshan</a> 常山) that has roots in the new scientific research on Chinese medicinals in 1940s mainland China.</p>
<p>It was validation of this traditional drug as an antimalarial in the 1940s, in fact, that <a href="http://press.uchicago.edu/ucp/books/book/chicago/N/bo18610904.html">set the foundation</a> for Chinese leader Mao Tse Tung’s directive two decades later in the late 1960s to find a cure for malaria. Indeed, Tu’s research is best understood within the complex politics and history of <a href="https://www.dukeupress.edu/chinese-medicine-in-contemporary-china/">top-down support from the Chinese government</a> of Chinese medicine in mainland China during the long durée of the 20th century, and not just in the Maoist period.</p>
<p>Even outside mainland China, though, such research has yielded results. In the 1970s, for example, US and Japanese researchers developed the statin drugs used to lower cholesterol from studying the mold <em><a href="https://en.wikipedia.org/wiki/Monascus_purpureus">Monascus purpureus</a></em> that makes red yeast rice, well, “red.” </p>
<p>Empirical evidence of the medical efficacy in the rich Chinese medical archive from centuries earlier similarly influenced the initial direction of this research. </p>
<h2>Medically bilingual</h2>
<p>So is this Nobel Prize for Tu’s discovery a signal that Western science has changed how it perceives alternative systems of medicine? Perhaps, but only slightly.</p>
<p>One of the Karolinska Institute panelists acknowledged that there are many sources from which scientists draw inspiration to develop drugs. Among them, we should not ignore the long history of experiences from the past. As he clarified, such sources may be inspirational, but the old herbs found there cannot be used just as they are. Don’t underestimate the sophisticated methods Tu used to extract the active Artemisinin compound from <em>Artemesia annua</em>, another one of the panelists concluded.</p>
<p>So the Nobel Prize is not only acknowledging this complete transformation of a Chinese herb through modern biomedical science into something powerfully efficacious, but also the <a href="http://www.laskerfoundation.org/awards/2011_c_description.htm">millions of lives saved</a> because of its successful application worldwide, particularly in the developing world.</p>
<p>But there’s something else that marks Tu as extraordinary vis-à-vis both her two fellow Nobel Laureates for medicine, William C Campbell and Satoshi Ōmura, and her more Western medically oriented colleagues in pharmacology. She embodies, in both her history and her research, <a href="https://www.dukeupress.edu/health-and-hygiene-in-chinese-east-asia">what I call medical bilingualism</a> – the ability not only to read in two different medical languages but to understand their different histories, conceptual differences, and, most importantly for this unexpected news, potential value for therapeutic interventions in the present.</p>
<p>This medical bilingualism is a quality that current researchers mining the same fine line between the empirical knowledge of traditional medical traditions and the highest level of modern biomedical science would be lucky to share with Nobel Laureate Youyou Tu.</p><img src="https://counter.theconversation.com/content/48643/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marta Hanson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The first Chinese Nobel Prize in medicine was awarded for work based on traditional Chinese medicine. Will traditional medical knowledge now share the spotlight with evidence-based medicine?
Marta Hanson, Associate Professor of the History of Medicine, Johns Hopkins University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/41177
2015-05-05T04:50:10Z
2015-05-05T04:50:10Z
‘Holistic’ dentistry: more poppycock than panacea?
<figure><img src="https://images.theconversation.com/files/80254/original/image-20150504-2070-1nt4ws1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">All dentists should be practising evidence-based dentistry for the sake of their patients.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/gobikey/4568757099">John Dill/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Many Australian dentists’ websites proudly advertise that they practise holistic dentistry, a philosophy that promotes health and wellness rather than simply treating disease, and considers the whole body and mind, not just teeth. </p>
<p>It sounds exciting. The implication is that this practice is very different – and superior – to the type of dentistry being practised by mainstream dental professionals. But different doesn’t actually mean superior.</p>
<p>Most holistic dental surgeries embrace and encourage alternative therapies. A quick internet search finds Australian dentists practising or endorsing <a href="http://www.lotusdental.com.au/homeopathy-dentistry/">homeopathy</a>, <a href="http://www.thepaddingtondentalsurgery.com.au/about/naturopath-sydney-nsw/">naturopathy</a>, <a href="http://www.davidhoward.com.au/services/wd_homeopathic.html">Bach flower essences</a>, <a href="http://www.myhillsdentist.com/service/acupuncture/">acupuncture</a>, <a href="http://www.naturaltherapypages.com.au/connect/liminac/service/37299">traditional Chinese medicine</a>, <a href="http://www.dentalpartners.com.au/practice-locations/new-south-wales/windsor-chiropractic-dentistry/">chiropractic</a>, <a href="http://www.shdc.com.au/tag/ayurvedic/">ayurvedic medicine</a>, <a href="http://www.brunswickdental.com">osteopathy</a>, <a href="http://www.oakdale.net.au">kinesiology</a>, <a href="http://www.brunswickdental.net/dentistry.php">crystals, aromatherapy, reiki</a>, <a href="http://www.veranese.com/#!dr-jon-dental/c2414">vibrational healing</a>, <a href="http://www.holisticdentist.com.au/vital-breathing-method.html">Buteyko</a> and <a href="http://www.evolvedental.com.au/about">esoteric chakra-puncture</a>.</p>
<p>Since all dentists are registered by the <a href="http://www.ahpra.gov.au/Notifications/Hearing-Decisions/Before-the-national-scheme/Dental.aspx">Australian Health Practitioner Regulation Agency</a>, the public tends to assume they must be reputable and their treatments, even if out of the ordinary, must be effective. And, surely, we have to respect the centuries of ancient wisdom from whence many of these therapies came, right? Well, yes and no.</p>
<h2>Not quite right</h2>
<p>Many ancient remedies have given us modern medical treatments. Hippocrates recognised that <a href="http://en.wikipedia.org/wiki/Willow#Medicine">powdered willow bark</a> (containing aspirin) alleviated headaches. South Americans used <a href="http://en.wikipedia.org/wiki/Jesuit%27s_bark#Medicinal_uses">cinchona bark</a> (containing quinine) to treat malaria. Traditional Chinese medicine gave us <a href="http://en.wikipedia.org/wiki/Ephedrine#Agricultural_sources">ephedrine</a>, a commonly used stimulant and decongestant, and the anti-malarial drug <a href="http://en.wikipedia.org/wiki/Artemisinin">artemisinin</a>. Both are now effective pharmaceuticals.</p>
<p>But doing something for centuries doesn’t automatically make it right. From the time of the ancient Greeks and Mesopotamians up to the late 19th century, <a href="http://www.history.com/news/a-brief-history-of-bloodletting">misguided medicos bled patients</a>, sometimes to death, in vain attempts to treat a multitude of ills. Bloodletting is still <a href="http://www.ibtimes.co.uk/bloodletting-razor-blade-india-leech-therapy-488462">a core belief</a> in some traditional health systems. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=659&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=659&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=659&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=829&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=829&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=829&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Doing something for centuries doesn’t automatically make it right.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/marceldouwedekker/7206160814">Marcel Douwe Dekker/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>And traditional Chinese medicine also uses rhino horns, tiger penises, shark fins and bear bile. Even ignoring the appallingly cruel way these “medicines” are obtained, none has any proven health benefits. Rhino horns are <a href="http://www.businessinsider.com.au/rhinos-horns-worth-more-than-gold-2012-5">more expensive by weight than gold</a>. As they consist largely of the protein keratin, purchasers could have saved a fortune by chewing their toenails.</p>
<p>Former Victorian dentist and self-styled “professor” Noel Campbell was practising (very) alternative dentistry in the late 1990s when charged with <a href="http://www.news.com.au/ozone-gas-healer-preyed-on-the-dying/story-fna7dq6e-1111117329113">administering ozone to a patient’s rectum to relieve her facial pain</a>. Not surprisingly, it didn’t work. </p>
<p>Campbell avoided disciplinary action by allowing his dental registration to lapse but continues to provide unproven alternative therapies to patients with cancer and other conditions through his website. And he’s not alone.</p>
<p>The recent cases of Wellness Warrior <a href="http://www.news.com.au/lifestyle/real-life/wellness-warrior-jess-ainscough-dies-from-cancer/story-fnq2o7dd-1227242521955">Jessica Ainscough</a> and The Whole Pantry’s <a href="http://www.mamamia.com.au/news/belle-gibson-cancer-claims/">Belle Gibson</a> show the importance of safe and effective health-care recommendations being based on more than a pretty smile and social media presence. </p>
<h2>Importance of evidence</h2>
<p>But aren’t some alternative therapies safe and effective? And how can we tell the difference? Thankfully, we have very good ways of determining if health treatments are effective. </p>
<p>The concept of <a href="http://www.community.cochrane.org/about-us/evidence-based-health-care">evidence-based health care</a> has arisen over the past few decades and is now almost universally accepted as the required standard for professional health practice. </p>
<p>Evidence-based dentistry accepts patients’ needs and preferences, while insisting treatments be based on the highest-quality scientific evidence and regular systematic reviews of published research.</p>
<p>Currently, most alternative therapies have a very limited <a href="http://www.ama.com.au/position-statement/complementary-medicine-2012">evidence base</a> to support their practice, and research methodologies are often poor. If a beneficial effect is shown, it’s often no greater than that <a href="http://www.nhs.uk/Livewell/complementary-alternative-medicine/Pages/placebo-effect.aspx">achieved by placebo treatment</a>, and <a href="http://www.quackwatch.com/01QuackeryRelatedTopics/altwary.html">less than that achieved by mainstream health care</a>.</p>
<p>Most “natural” medications have never been placed on the <a href="http://www.tga.gov.au/australian-register-therapeutic-goods">Australian Register of Therapeutic Goods</a> simply because they’ve never shown effectiveness. And alternative therapies found to be safe and effective become part of the mainstream health-care arsenal.</p>
<p>Does that really matter though, as long as patients receive the treatment they want and feel better as a result? Yes, it does matter. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A patient-dentist relationship must be based on trust and professionalism.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/trypode/6347677054">The Guy With The Yellow Bike/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Most holistic dental practices will provide a wonderfully caring and nurturing environment for patients, but a patient-dentist relationship must also be based on trust and professionalism. A dentist who provides or endorses treatment options based on centuries of “eye of newt and toe of frog” without finding out if any beneficial effect is real or merely a placebo is not acting in the patient’s best interests, even if their belief is genuine. </p>
<p>Not only is any placebo effect unlikely to be maintained in the long term, patients may have wasted considerable amounts of money and been deprived of legitimate treatments that could have provided much greater benefits.</p>
<h2>Still the same</h2>
<p>More than 2,000 years ago, Hippocrates wrote:</p>
<blockquote>
<p>There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance. </p>
</blockquote>
<p>The public expects all health professionals to practise competently, ethically and professionally. Would you prefer a dentist who provides treatment and advice based on evidence from the most recent and highest-quality research studies, or based on clouds of dubious and scientifically unsupported mysticism?</p>
<p>In 1948, the <a href="http://www.who.int/about/definition/en/print.html">preamble to the constitution of the World Health Organisation</a> defined health as “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity”. This description still holds up today, and sits very well with the concept of holistic dentistry. So holistic dentistry is really nothing new. </p>
<p>All dentists should be practising holistic dentistry. And they should all be practising evidence-based dentistry, too.</p><img src="https://counter.theconversation.com/content/41177/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Foley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Holistic dentistry claims to promote overall wellness rather than simply treating disease. But the lack of evidence for the alternative therapies underpinning it are cause for concern.
Michael Foley, Senior Lecturer, Public health dentistry, The University of Queensland
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/14982
2013-06-06T05:49:22Z
2013-06-06T05:49:22Z
Misguided ‘war on poaching’ will not save the wild beasts
<figure><img src="https://images.theconversation.com/files/25113/original/nd6vfh9v-1370454974.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Neither laws nor guns are stopping the poachers.</span> <span class="attribution"><span class="source">Grø Åmert/Flickr</span></span></figcaption></figure><p>Rhinos, elephants and the big cats like lions and tigers are all at risk of extinction as a result of a resurgence in the illegal trade of their body parts. Newspapers in <a href="http://www.guardian.co.uk/environment/africa-wild/2013/jun/03/rhinos-killed-kenyas-bloodiest-week">recent days</a> have been filled with the gruesome pictures of rhinos and elephants, their horns and tusks ruthlessly cut away.</p>
<p>Current <a href="http://www.cites.org/">international policy</a> is to significantly invest in anti-poaching strategies and to reduce demand. In my view this is doomed to failure, because policy makers do not fully understand the complex social, cultural and economic nature of the wildlife trade. It is not a simple law enforcement problem, as western based conservation NGOs would have us believe.</p>
<p>The illegal trafficking of ivory and other wildlife parts is a billion dollar trade and it is unrealistic to expect demand reduction to work in the short term. The crazy prices - by weight, <a href="http://www.freakonomics.com/2011/08/15/why-are-rhino-horns-twice-as-valuable-as-gold/">more than gold, more than cocaine</a> - that are being offered simply reflect the very high value rich Asian businessmen place on them. Demand reduction programmes are powerless in the face of market forces unleashed by globalisation and exponential economic growth in countries such as <a href="http://www.savetherhino.org/rhino_info/threats_to_rhino/poaching_for_traditional_chinese_medicine">China and Vietnam</a>. Cultural change to reduce demand takes time, and with only a few hundred black rhino left, for example, time is something we don’t have. Indeed, in the next five years, with the increased penetration of China into the African continent, prices will continue rising as the animals become scarcer and trade and supply chains even more established.</p>
<p>Greater emphasis on enforcement is also <a href="http://bjc.oxfordjournals.org/content/49/4/451.full">misguided</a>. First, effective enforcement will only drive prices up, which in turn encourages more poaching. Second, enforcing trade restrictions in countries in sub-Saharan Africa and South-East Asia that are rich in biodiversity but economically poor is highly problematic. Wildlife trade is intrinsically linked to livelihood strategies, tenure rights, governance issues and cultural practices along the length of the trade chain. A strict supply-based approach also generates negative outcomes for the rural poor who are most dependent on wildlife resources for their livelihood. In short, a political minefield, into which it is unlikely politicians will be tempted to stumble by funding the measures necessary to be effective.</p>
<p>What we need is a complete step-change in our approach to avoid the tragedy of these iconic species becoming extinct. Right now, we need to recognise that local people, many of whom live in crippling poverty, hold the key to the survival of these wonderful creatures. We need to divert money currently being funnelled into ineffective conservation projects run by governments and conservation NGOs directly into the hands of local communities. They should be empowered, equipped and paid to protect their wild charges from poachers. With a few notable exceptions around the world, local communities have at best been bystanders as the battle between conservationists and poachers wages on. What we need to do is change the game, recognising that it is right and proper that local people can escape poverty by protecting valuable wildlife using whatever approaches are deemed effective and legal.</p>
<p>What’s so wrong with people getting rich from protecting an animal? Why not pay people ten times more than they currently earn from their traditional livelihoods as wildlife guardians? The world can easily afford it - we cannot afford not to if we care about these beautiful beasts’ survival. Much of the money needed to do this is already there and can be redirected from the funds of existing under-performing conservation strategies.</p>
<p>In the medium term we need also to look again at proposals to allow limited hunting and trade in the body parts of some of these species. This would create a sustainable flow of funds for the future and create a legitimate trade in valued products such as ivory, but with trade volumes monitored and taxes paid.</p>
<p>High taxation will be critical to the success of any legalised trade. In order to pay for the costs of management and enforcement, yes, but also to make those who consume horn and ivory pay the full and proper price for their destructive use of wildlife.</p><img src="https://counter.theconversation.com/content/14982/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Douglas MacMillan receives funding from ESRC</span></em></p>
Rhinos, elephants and the big cats like lions and tigers are all at risk of extinction as a result of a resurgence in the illegal trade of their body parts. Newspapers in recent days have been filled with…
Douglas MacMillan, Professor of Conservation and Applied Resource Economics, University of Kent
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/6373
2012-04-12T21:05:07Z
2012-04-12T21:05:07Z
Are traditional Chinese medicines safe and legal?
<figure><img src="https://images.theconversation.com/files/9519/original/p62h9prn-1334210649.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Traditional Chinese medicines the authors genetically audited using new DNA sequencing technology.</span> <span class="attribution"><span class="source">M.Bunce</span></span></figcaption></figure><p>There are polarising views on the subject of complementary and alternative medicines (CAM). This website has recently published numerous article about the <a href="https://theconversation.com/does-traditional-chinese-medicine-have-a-place-in-the-health-system-6166">efficacy</a> and <a href="https://theconversation.com/consumers-need-the-facts-about-complementary-medicines-3318">regulation</a> of CAM, the <a href="https://theconversation.com/panacea-or-placebo-doctors-should-only-practise-evidence-based-medicine-2212">placebo effect</a> and whether <a href="https://theconversation.com/what-cam-courses-at-universities-should-look-like-5339">universities should train practitioners</a>.</p>
<p>We don’t intend to cover this well-trodden ground. Rather, we’re sharing the results of research into the legality, safety and honesty in the labels of some traditional Chinese medicines (TCM).</p>
<h2>Mystery ingredients?</h2>
<p>When you buy a food product at the supermarket, you expect the manufacturing standards to be high; the product to be safe; and the ingredient list to accurately depict what’s in the product – regardless of whether it is locally grown or imported. </p>
<p>Surely the same or an even greater level of honesty is expected of medicines. Few would argue that consumers shouldn’t be provided with accurate information about medicinal products before deciding to ingest them. </p>
<p>This is especially important for CAM because the majority of herbal medicines are self-prescribed and administered. And because traditional Chinese and other herbal medicines are commonly processed into powders, pills or teas it’s difficult to reliably identify all their ingredients. </p>
<p>We set out to investigate the biological origins of traditional Chinese medicines by examining the DNA signatures of animals and plants contained within 15 medicines. The aim of our research, published today in the journal <a href="http://www.plosgenetics.org/doi/pgen.1002657">PLoS Genetics</a>, was to see if <a href="http://454.com/products/gs-junior-system/index.asp">new DNA sequencing technologies</a> were effective in providing detailed audits of the plant and animal ingredients within selected products.</p>
<p>The results of the genetic audit don’t make pretty reading: we found this collection of traditional Chinese medicines routinely contain undeclared plants and animals, some of which are illegal.</p>
<h2>What’s in a horn?</h2>
<p>One product labelled 100% “Saiga Antelope Horn Powder” contained DNA of Saiga antelope (an endangered species protected by the Convention on International Trade in Endangered Species of Wild Fauna and Flora (<a href="http://www.cites.org/">CITES</a>)) – so this ingredient was accurately declared.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/9520/original/5bp4chzd-1334210676.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/9520/original/5bp4chzd-1334210676.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9520/original/5bp4chzd-1334210676.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9520/original/5bp4chzd-1334210676.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9520/original/5bp4chzd-1334210676.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9520/original/5bp4chzd-1334210676.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9520/original/5bp4chzd-1334210676.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">100% Saiga antelope horn powder - or is it?</span>
<span class="attribution"><span class="source">(M. Bunce)</span></span>
</figcaption>
</figure>
<p>But DNA from sheep and goat were not mentioned on the packaging but were found in significant amounts. What’s not known is whether products from sheep and goats were intentionally added as bulking agents or were accidentally introduced during the manufacturing process. </p>
<p>This traditional Chinese medicine also contained 13 different families of plants that were not declared. Clearly, the manufacturer’s claim of 100% Saiga antelope horn is false.</p>
<h2>The dangers of plants</h2>
<p>Unravelling the origins of the plants within traditional Chinese medicines represents a more challenging task than the identification of animals. This is because of both the sheer number of species used and the fact that plant DNA databases are a work in progress. </p>
<p>Within the 15 traditional Chinese medicines we tested, we detected 68 distinct families of plants encompassing scores of plant species. Clearly these products are complex blends of plant material – perhaps more complex than manufacturers realise, and certainly more complex than what’s declared on the list of ingredients.</p>
<p>Of particular concern to consumers is that some of the traditional Chinese medicines contained undeclared <em>Ephedra</em> and <em>Asarum</em> species. These plants can contain chemicals that are toxic in the wrong dose – but none of products with them actually listed a dose. </p>
<p><em>Ephedra</em> is classed as a poisonous herb and products containing its extracts have been <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2004/ucm108379.htm">banned</a> by the United States drug regulator, the <a href="http://www.fda.gov/">Food and Drug Administration (FDA)</a>, since 2004. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/9535/original/xppgy4sw-1334215552.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/9535/original/xppgy4sw-1334215552.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9535/original/xppgy4sw-1334215552.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9535/original/xppgy4sw-1334215552.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9535/original/xppgy4sw-1334215552.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9535/original/xppgy4sw-1334215552.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9535/original/xppgy4sw-1334215552.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1127&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ephedra equisitina - DNA from plants of the genus <em>Ephedra</em> was detected one of the tested medicines.</span>
<span class="attribution"><span class="source">Cheryll Williams/Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>Plants in the genus <em>Asarum</em> often contain Aristolochic acid, a known nephrotoxin (damaging to the kidneys), hepatotoxin (damaging to the liver) and carcinogen. <a href="http://www.pnas.org/content/early/2012/04/03/1119920109.abstract">Research published this week</a> provides strong evidence of the link between Aristolochic acid in herbal medicines and the high incidence of urinary tract cancers in Taiwan. </p>
<p>To complement our genetic identification of <em>Asarum</em>, we conducted a metabolomic audit (capable of detecting chemicals in the traditional Chinese medicine) in a product labelled “laryngitis pills”. We were able to confirm the presence of Aristolochic acid.</p>
<p>We also detected the presence of DNA from the soy and nut families of plants, which may be of concern to consumers who have allergies. And again, the plants were not declared in the ingredient list of the products.</p>
<h2>Concerns for consumers?</h2>
<p>The issue of undeclared constituents has implications for consumers with religious beliefs or cultural practices (such as vegetarianism) that prohibit the eating of certain substances. Tianbao pills, for instance, contained cow DNA, and taking these pills may violate religious or cultural strictures (for instance, Hindus).</p>
<p>This problem is likely to grow as traditional medicines are <a href="https://www.mja.com.au/journal/2006/184/1/continuing-use-complementary-and-alternative-medicine-south-australia-costs-and">increasingly being used</a> by an ever wider cross-section of Australian society.</p>
<p>It’s manifestly obvious that herbal medicines should be carefully evaluated for legality, accurate disclosure of ingredients and pharmacologic activities. We advocate for the development and uptake of a combined genetic and metabolite auditing program to improve consumer safety.</p>
<p>Such a program could help regulate the herbal medicine market and, if implemented, would put manufacturers and importers on notice to accurately declare contents of traditional Chinese medicines and other CAM. </p>
<p>There’s a commonly held belief that because CAM are “natural”, herbal remedies, they’re <a href="http://www.nps.org.au/research_and_evaluation/publications/reports/ComplementaryMedicinesReport">healthy</a>. This is clearly not so, and nor does it necessarily follow that traditional medicines are safe because they have a long history of use. </p>
<p>A recent opinion piece in the journal <a href="http://www.nature.com/nature/journal/v480/n7378_supp/full/480S90a.html">Nature</a> said, “if TCM is to take its place in the modern medicine cabinet, then it must develop ways to prove itself”.</p>
<p>We concur and believe it applies to all herbal medicines. What’s more, it’s applicable to questions of efficacy, labelling and safety. </p><img src="https://counter.theconversation.com/content/6373/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Bunce receives funding from The Australian Research Council.</span></em></p><p class="fine-print"><em><span>James Haile does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
There are polarising views on the subject of complementary and alternative medicines (CAM). This website has recently published numerous article about the efficacy and regulation of CAM, the placebo effect…
Michael Bunce, ARC future fellow researching in the fields of ancient DNA and wildlife forensics , Murdoch University
James Haile, ARC DECRA Fellow. Ancient DNA, Molecular Archaeology, Environmental DNA, Murdoch University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/6166
2012-04-02T01:02:44Z
2012-04-02T01:02:44Z
Does traditional Chinese medicine have a place in the health system?
<figure><img src="https://images.theconversation.com/files/9183/original/frdgzv2p-1333327588.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Despite recent attempts to retain traditional healing practices in China, modern medicine is supplanting traditional medicine there.</span> <span class="attribution"><span class="source">Jean-François Chénier</span></span></figcaption></figure><p>Most of traditional healing practices are based on intuitive principles of diseases involving the imbalance of elemental qualities. </p>
<p>For the ancient Greeks and Romans, whose systems of traditional healing were accepted in Europe until the scientific revolution, these elements were the four bodily fluids or humours. Each corresponded to the four fundamental elements of the world – earth, water, air and fire. </p>
<p>In traditional Chinese medicine, the elements are wood, fire, earth, metal and water; for the ancient Unani medicine in India, the four humors (akhlaat) are air, earth, fire and water; for Indian Ayurveda medicine, health is the balance of three elemental energies in the universe: air, water and fire.</p>
<p>None of the ideas have any scientific basis. </p>
<p>With the advent of modern medicine, traditional European practices were relegated to a handful of surviving herbal remedies. Similarly <a href="http://www.nature.com/nature/journal/v480/n7378_supp/full/480S82a.html">in China</a>, despite <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.93.7.1082">recent attempts to retain</a> traditional healing practices, modern medicine is supplanting traditional medicine.</p>
<p>Paradoxically, in Australia and other developed countries there’s increased interest in complementary and alternative medicines, reverting to irrational approaches to health practice, despite people from such countries benefiting most from medicine’s advances.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1127&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chinese medicinal herbs.</span>
<span class="attribution"><span class="source">Jennifer Yin</span></span>
</figcaption>
</figure>
<p>The <a href="http://www.health.wa.gov.au/publications/documents/discussion%20paper%20-%20regulation%20of%20practitioners%20of%20chinese%20medicine%20in%20wa.pdf">resurgence of interest</a> in traditional Chinese healing in Australia, along with other alternative medicines, is due to rising discontent with conventional medicine; a preference for natural (or gentler) alternatives to pharmaceutical drugs or surgery; desire for greater control over personal health care and the relatively low success rate of conventional medicine in treating conditions, such as chronic pain, for some individuals.</p>
<p>This has led to the recent contentious decision to permit traditional Chinese medicine practitioners to be registered with the new national <a href="http://www.chinesemedicineboard.gov.au/">Chinese Medicine Board of Australia</a> from July this year. The board will be a new member of the <a href="http://www.ahpra.gov.au/">Australian Health Practitioner Regulation Agency</a>. </p>
<p>I have argued against the move, along with my colleague Associate Professor Hubertus Jersmann, in articles published today in <a href="http://www.mjainsight.com.au/view?post=marcello-costa-hubertus-jersmann-chinese-paradox&post_id=8680&cat=comment">MJA Insight</a> and the <a href="http://www.smh.com.au/national/health/alarm-bells-sound-on-registration-of-chinese-medicine-20120401-1w6mo.html">Sydney Morning Herald</a>.</p>
<p>The decision follows Victoria’s move (in 2000) to register traditional Chinese medicine practitioners, which has had a <a href="http://www.publish.csiro.au/paper/AH10869.htm">positive impact</a> on tightening standards and dealing with complaints. </p>
<p>Among traditional Chinese medicine practitioners to be registered are those who provide Chinese medical diagnosis, dispense Chinese herbs and perform acupuncture. All three components of this practice have serious flaws, being based on non-existent energies (Yin and Yang), non-existent bodily structures (meridiens) and on principles of disease diagnosis based on the imbalance of five non-existent elements. It is therefore doubtful whether such practitioners are able to make correct and safe diagnoses.</p>
<p>Proponents of traditional medical practices often point out that extracts from animals and plants have been the source of effective remedies in modern medicine. And while pharmacology and medicinal chemistry have enabled this revolution since mid-1800s, only a handful of the extracts used in traditional healing have been proven to contain active principles beneficial for fighting disease. These include about 120 chemical substances out of the thousands of <a href="http://www.hindawi.com/journals/ecam/2005/629537/abs/">herbal remedies</a> used in traditional medicines. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=713&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=713&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=713&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=896&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=896&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=896&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Artemisia annua or qing hao su became incorporated into medicine after it’s anti-malarial activity was proven through research.</span>
<span class="attribution"><span class="source">Scamperdale</span></span>
</figcaption>
</figure>
<p>Take, for instance, qing hao su, a herb used in China for treating fever for over 2,000 years. About 40 years ago, scientific research found that it had specific anti-malarial activity and its active compound, artemesin, was isolated. </p>
<p>In fact, it’s fortunate that most herbal remedies have little acute toxicity. This is due to empirical experience, which over time has selected out those proven to be overtly toxic. But the more subtle, chronic toxicity of herbal remedies remains a serious concern. </p>
<p>Only <a href="http://www.hindawi.com/journals/ecam/2005/629537/abs/">6% of plants species</a> have been screened chemically and pharmacologically to identify their active principles. This process, started by modern medicine just over 150 years ago, is continuing with investigations of potential benefits of new therapies often based on a long history of empirical evidence.</p>
<p>This is why research on active chemical principles in herbal remedies showing some potential beneficial effect is fully supported by the <a href="http://www.scienceinmedicine.org.au/">Friends of Science in Medicine (FSM)</a>, of which I am a founding member. </p>
<p>FSM represents a growing number of medical researchers, clinicians and members of the public concerned by the “current trend which sees government-funded tertiary institutions offering courses in the health care sciences that are not underpinned by sound scientific evidence”. We are worried that this gives unwarranted credibility given to their practitioners and practices, including traditional Chinese medicine. </p>
<p>Even though it falls within traditional Chinese medicine, acupuncture requires separate consideration because, despite being based on a flawed theory of non-existent “meridiens”, it has shown promising effectiveness in some ailments. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Acupuncture is based on the idea of “meridiens”.</span>
<span class="attribution"><span class="source">aloucha</span></span>
</figcaption>
</figure>
<p>But it’s important to remember that despite its popularity, acupuncture has only proven beneficial in alleviating some symptoms of pain and nausea. And the mechanisms by which it appears to work are similar to the physiological processes in the nervous system underlying the placebo effects on pain. Ultimately, research on acupuncture has enabled it to become incorporated in medicine in the few conditions for which it has proven to be effective.</p>
<p>My view, shared by many, is that there’s only one medicine and adjectives such as traditional and “Western” are irrelevant. Rather, medicine is about efficacy and safety, proven through scientific research. </p>
<p>Living in a modern society requires that in matters of health, we unapologetically only accept practices that have undergone the scrutiny of science. And once that criteria is fulfilled, we can accept it as effective medical treatment and teach it in our universities.</p>
<p>Sadly, this is not the case for most traditional Chinese medical practices and practitioners.</p><img src="https://counter.theconversation.com/content/6166/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marcello Costa does not work or consults for, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant undisclosed affiliations. Marcello as member of the Australian Academy of Science, is committed to support the highest scientific standard in education and tertiary institutions.
He is one of the five founding members of the Friends of Science in Medicine.</span></em></p>
Most of traditional healing practices are based on intuitive principles of diseases involving the imbalance of elemental qualities. For the ancient Greeks and Romans, whose systems of traditional healing…
Marcello Costa, Professor of Neurophysiology, Department of Physiology, Flinders University
Licensed as Creative Commons – attribution, no derivatives.