Science starts with an observation of a curious phenomenon. Stubbed your toe on the edge of the bed? Rubbing it seems to help? Well, turns out nerves activated by touch can inhibit the transmission of pain from nociceptors. But back before we had the kind of technology to easily connect those dots, the importance of making these inferences themselves was vital for the healthcare of communities.
In fact, numerous ancient societies did just that; they carefully observed both the beneficial and detrimental properties of their local flora and fauna. Many of these practices survived from Ancient Greece and Egypt, coming to be known over time as traditional medicine. Today the World Health Organization (WHO) defines this as “the accumulation of knowledge, skills and practices by the experience of various indigenous peoples used in the prevention, diagnosis, treatment and improvement of various illnesses.” This is by no means, a passing fad. More than 100 countries have some kind of regulation or policy for the implementation and sale of traditional therapeutics alongside modern medicine. But perhaps no country has done this more prominently than China, which has a long history of its own traditional Chinese medicine (TCM) dating back to the 3rd century B.C.
In recent years, TCM has contributed $50 billion(USD) of annual revenue to its economy, due in no small part, to the rising exposure of therapies like acupuncture and cupping, as well as easier access to various herbs and flowers from online markets. To that end, China has recently opened multiple TCM centres in more than 24 cities across the nation. Despite there being significant controversy in the scientific community about the efficacy of various TCM practices, the sale of herbal supplements contributed $8 billion USD to the U.S economy in 2017 alone. Unsurprisingly, in 2019,the WHO added TCM practices to their International Statistical Classification of Diseases and Related Health Problems (ICD), albeit to a mixed reception in the medical community.
How cynical should we be though? After all, ubiquitous drugs of today, such as aspirin and codeine, came about through examining, isolating, and synthesizing natural chemicals (such as salicylic acid) from plants (such as willow bark) that had been used in traditional medicinal practices for years. In fact, the study of TCMs earned Chinese chemist, Tu Youyou, the 2015 Nobel Prize in medicine for her identification of the anti-malarial agent derived from wormwood, artemisinin. Her finding was influenced by a 4thcentury Chinese medical herb formula and has since been used to help millions of individuals with malaria.
There is, however, a darker side to these practices. Traditional medicine has a long history of using animal products in their prescriptions. For example, the use of bear bile acids has been widespread, particularly in China. Chinese texts dating as far back as the 8thcentury, describe its use for the treatment of liver conditions, epilepsy, hemorrhoids, and heart pain. As such, the farming of bears, specifically to isolate their bile acids, began in earnest in the 1980s. To that end, thousands of bears are kept caged, living for decades in captivity. These bears are at risk of catching diseases and infections due to poor living conditions. Not only that, but the process of bile extraction is painful; often a catheter, syringe or even a pipe is inserted into their gall bladders. While the products may come from countries like China, Japan, or Taiwan, they can be found in markets worldwide including Australia, Singapore, the U.S and even Canada.
Bears are by no means the only animals at risk. Pangolins, geckos, musk deer, antelopes, seahorses, rhinos, and tigers have also been used in TCM. Powdered rhino horn has been traditionally used for treating fevers or headaches, despite little scientific evidence to support its efficacy. The increased demand for these kinds of animal products has been argued to be a primary factor in driving poaching and endangerment of their populations in the wild. There has been a recent effort, driven by public demand, to look for plant-based substitutes for many animal products. For example, the use of tiger bone, used to treat pain and strengthen ligaments/tendons, could be replaced by ‘red sage’ or ‘Sang ji sheng’ (from the mistletoe family). But it is important to remember that people’s perceptions of what these products can do is mostly without evidence. A survey by the San Francisco–based charity, WildAid, showed that 71% of respondents in the Vietnamese cities of Hanoi and Ho Chi Minh believed that rhino horn had health benefits, with 62% believed it could cure assorted diseases, specifically cancer. Many people believe consuming the penises of various animals helps to improve virility. This has become especially popular in China following the end of the one-child policy.
Even ignoring the ecological dilemmas for a moment, the question becomes: how do we begin to regulate it all? Is there even a way to standardise the large-scale production of medicinal grade herbs? We know from plants like the coffee bean and marijuana, that the potency of many relevant active chemicals varies based on differences in soil, temperature, altitude, and a host of external conditions that are not standardized across providers. This is of concern for each plant used in a new herbal remedy, with more herbs resulting in more variables to deal with and unknown toxicities. As for animal products like the bear bile mentioned previously, different countries have different farming policies and varying ideas of what is considered “ethical”. It is legal in China but not in Vietnam, for example.
Like many things, investment in traditional medicine, comes with both pros and cons. Like modern drugs, which fuelled the opioid crisis, unregulated and unsubstantiated traditional remedies could be extremely dangerous. For example, a commonly used ingredient in some traditional remedies, aristolochic acid, has been linked with kidney damage and urinary tract cancers. Despite that, it is undeniable that our knowledge of traditional practices has often pointed us to promising therapeutic agents and may well continue to do so. Today, scientists are attempting to see if components in bear bile, such as fatty acids and delta opioids that help bears survive hibernation, can be used to extend organ survival for transplants. This could help in the transport of available organs to thousands of people on transplant lists worldwide.
There is a path forward for an evidence-based drug discovery approach that incorporates both traditional and contemporary medicine. But it will not be easy. For one, it would require establishing internationally accepted ethical guidelines and policies that are not influenced by potential economic and political gains. Transparent and open communication with the scientific community about the evidence for and against any new suggested medications, as well as the associated ecological burden, is important in order to truly benefit from the harmony of medicinal knowledge accumulated over generations and modern scientific techniques.
Shanzeh Ahmed
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