Is there a role for trado-medicine in the Nigerian health sector? (6)

1 January, 2019

Dear Neil,

Happy new year to all!

I am quite surprised that the same topic is brought up again (and again). I reconciled Joseph that the role of TM is not in question. We need more resources to consolidate the evidence and evaluate the effectiveness of TM.

For the specific condition that TM can do better or at least to fill the gap, I think I have already provided enough examples published on JAMA and other journals in previous messages. It would be too time consuming and impractical to list one by one on this platform. You may refer to some web resources to get specific conditions reviewed, eg British Acupuncture Council (https://www.acupuncture.org.uk/). There are many other systematic reviews or interventional studies in databases as well.

My particular interest is on diabetic kidney disease and we are running trials, animal studies and reviews. It is not the right time for me to disseminate the result here as it is recently about to complete. However, big data studies from other regions has already showed that the use of Chinese medicine on top of standard care is associated with 40-60% risk reduction of mortality and / or end-stage kidney disease in 4-6 years’ time which looks even better than the newer DPP-IV inhibitors / SGLT2 inhibitors. And the formulations used were from 2000 thousand years ago when we do not even have the concept of blood glucose. You may refer to these registry studies:

https://www.kidney-international.org/article/S0085-2538(15)61041-9/fulltext

https://www.frontiersin.org/articles/10.3389/fphar.2018.01117/full

https://www.hindawi.com/journals/ecam/2017/5632195/

For harm vs benefit, I am sure if you go for a thorough search on the electronic databases, evidence on the positive effect/mechanism far outweighs the harm. I am surprised to hear a continuous call for evidence of efficacy while stating evidence of harm is abundant. Any evidence to support that?

For direct harm, I think it depends on whether the right medicine at the right dosage is used on the right condition. Of course, some TM may be lethal when used overdose/on wrong condition. But isn’t it the same for conventional medicine? Take a look on the NSAIDs-related kidney failure. We see more NSAIDs-related kidney disease patients than Chinese medicine-related cases. Also, the ACEI we have been using for more than 2 decades was recently associated with increased risk of lung cancer revealed by big-data. (https://www.bmj.com/content/363/bmj.k4209). I think we need a more balanced view on the risk-benefit assessment of TM.

I agree that we need more researches to assess effectiveness but the priority should be on clinical research as they are in use already. Plenty of evidence and discussion on BMJ, Lancet, JAMA showed that many animal models do not replicate effect on human. Big data will serve as an important way to study the actual effect which reconciles the recent advocacy on the use of big data on pharmacovigilance. And we need more talents who have a deep understand on both sides to conduct these researches to avoid bias. Not much interventions from medicine / TM has support of perfect evidence. Many effective treatments would be called / presumed to be placebo if one tends to interpret in that way. Also, we need to keep the same eye on efficacy and adverse effect.

Best,

Chris

HIFA profile: Chris received training in basic science, biomedical science, clinical Chinese medicine, public health and basic science from the University of Hong Kong, Hong Kong Baptist University and London School of Hygiene & Tropical Medicine. He is currently a research clinician based in Hong Kong and has been actively engaged in clinical medicine, clinical trials, basic science research and qualitative research. He had served for Hospital Authority, World Health Organisation, KPMG Advisory and hospitals on research consultancy, medical administration and clinical medicine in Hong Kong and mainland China before his academic engagement.