TCM has huge potentials: ‘Iron Lady’
Xinhua - The traditional Chinese medicine (TCM) has broad prospects and huge potentials in its development, Chinese vice premier Wu Yi said. Read more
70% breast cancer patients use alternative medicine
CM NEWS - Younger women with higher anxiety level about cancer are more likely to try complementary and alternative medicine (CAM), a study says. Findings say about 70% of breast cancer patients or survivors choose CAM and the most popular CAM is herbs. Read more
Traditional medicine modernization - still a long, bumpy road ahead
Interfax - As drug discovery options run dry with fewer and fewer synthetic lead compounds and structure-based medicines being discovered, multinationals are increasingly turning to traditional Chinese medicines as a new source.
TCM modernization, the identification of an active ingredient in a herbal remedy that results in the mass production and marketing of a drug with a detailed pharmacokinetic profile, is the latest buzzword in the pharmaceutical industry, both home and abroad.
However, medical researchers have told Interfax that China’s TCM modernization is still in its early stages, and that a lack of standards and technology are inhibiting the modernization of TCMs.
Bottlenecks in TCM development
“There is no standard to assess the quality and efficacy of TCMs,” said Tang Senping, a senior researcher from the Shanghai Institute of Materia Medica. “So many researchers have to explore ways for the TCM sector to modernize.”
A lack of a set of standards for the industry is just one of the obstacles standing in the way to developing China’s TCM industry.
According to a TCM researcher, surnamed Bi, from the Institute of Materia Medica of the Chinese Academy of Medical Sciences, the more chemical analyses that are made on traditional Chinese medicine materials, the fewer the number of active ingredients are being discovered. “This in turn poses a technological challenge for TCM development,” Bi said.
It is also common that different TCMs will be used to treat patients with the same disease, and that when a TCM is used in a clinical trial, it often produces different clinical effects depending on the patient, Bi said.
Capital is also a key issue in TCM development. Some Chinese drug makers have developed TCM drugs with as little as 8 m yuan (US$1.05m), compromising safety and efficacy.
Artemisinin - China’s TCM success story
“China’s TCM modernization is still in its early stages,” Bi said. To date, only one Chinese-developed drug, artemisinin, has received international acclaim for its effectiveness in treating malaria symptoms.
Artemisinin, a substance extracted from the plant Artemisia annua L (sweet wormwood), has received approval from the World Health Organization for use in combination therapy to combat multi-drug-resistant Plasmodium falciparum, a widespread form of malaria that contributes to more than 500 million severe infections and more than 1 million deaths a year around the world.
Artemisinin has been used by Chinese people for centuries to treat fever but was further developed in 1972 by Chinese scientists as a remedy for malaria.
In response to increasing resistance to anti-malarials, the WHO recommends ACTs (artemisinin-based combination therapy) as the preferred alternative in areas experiencing resistance to conventional monotherapies.
There are now four ACTs available commercially. However only one, Coartem, a combination anti-malarial developed by Novartis AG, has received WHO pre-qualification, which means it meets standards that make it acceptable for procurement by United Nation agencies. The treatment, which was first registered in 1998, contains artemether, a derivative of artemisinin, as well as lumefantrine.
Currently Chinese pharmaceutical companies such as Kunming Pharmaceutical Group Ltd. supply Novartis with the raw materials for Coartem while Shanghai Fosun Pharmaceutical has teamed up with scientists from the Chinese Academy of Sciences to develop a new anticancer drug based on artemisinin.
TCMs to treat epidemics
AIDS, bird flu, SARS. You name the epidemic and more than likely, there is a TCM to treat it.
TCM experts convening at a seminar held by China’s Ministry of Health, the WHO and China Association of Chinese Medicine, agreed to formulate China’s own approach to the prevention and treatment of human avian influenza, by combining TCMs with modern medicine, according to Chinese media in January.
A similar treatment approach was developed in 2004 during the SARS epidemic. However, officially, the WHO does not recommend any herbal treatments for use in any disease.
In such cases, TCMs are being used as complementary medicines alongside western medicines to improve the immunity of patients.
“The big issues for herbal therapies in the eyes of Western patients and physicians are safety. Certification for purity and consistency of dosing is key. Another issue is drug-drug interaction [the effects of mixing one drug with another], a fact often overlooked when people buy medicines,” chief medical officer of World Link in China, Dr. Larry Perin, said.
China has long advocated the use of TCMs to treat AIDS and the MoH has subsidized or offered free treatment to poverty-stricken AIDS patients as a substitute for more expensive western drugs. However, while TCMs may be cheaper and enable broader treatment access to AIDS patients across China, scientific evidence and efficacy still remains a large, unanswered issue. Furthermore, drug interactions further increase the uncertainty of treatment with TCMs.
TCM development by multinationals
Some multinational companies are cooperating with Chinese research institutions on the development of plant medicines.
“The Institute of Materia Medica of the Chinese Academy of Medical Sciences has already cooperated with several foreign companies on the development of TCMs over the past two or three years,” Bi said.
Those co-operations include relationships with Taisho Pharmaceutical Co. Ltd., Bayer and Servia, which has lasted for more than 20 years. The institute received $8 million from Taisho to develop China’s first anti-hepatitis drug, bicyclol.
In November, 2004, the Shanghai Institute of Materia Medica and Novartis Pharma AG extended their cooperation on the research of plant medicines.
On the same day, phase one studies at Hutchinson Whampoa Ltd.’s TCM modernization research and production base was completed with an investment of 30m yuan (US$3.94m).
The Shanghai University of Traditional Chinese Medicines established its Ferid Murad TCM Modernization Center in 2003, to explore the relationships between nitric oxide and cardiovascular diseases, nervous system diseases, endocrine system diseases and inflammatory processes, and develop new strategies for the prevention and control of those diseases.
What will modernization do to China’s TCM industry?
TCM treatment is applied when the body’s forces, the yin and yang, are out of balance. There are other theories such as the five elements, Qi, Shen and the meridian system of the body, but the key concepts focus on the body attaining homeostasis and harmony through a holistic approach to maintaining good health.
Based on Taoist philosophy and more than 2000 years of experience, the main aspects of TCM treatment include acupuncture, moxibustion (application of heat on the body) and the use of Chinese herbal medicine.
Western medicine, on the other hand, is largely based on the symptom and cure method.
However, China’s TCM market already encompasses a whole spectrum of commercialized over-the-counter symptom-based cures readily available from the country’s 260,000 drugstores.
Many of these products are purchased without the advice of a TCM practitioner and more often, a pharmacist is not involved in the sale either. According to Zhang Shufang, the secretary-in-chief of the China Licensed Pharmacists Association, there are only 120,000 licensed pharmacists in China.
Already, this mass-marketing approach signals that perhaps, there could be loopholes in TCM theory.
Furthermore, China’s turn to “modernization” will be sure to rile some fundamentalist TCM scholars. The essential aim of modernization is to detect, formulate and apply the active ingredient of a TCM herb using western scientific approaches, otherwise known as evidence-based medicine.
Such a process will probably be no more different to that used in discoveries such as digoxin, an extremely potent medication for heart arrhythmia, and the tumor-killing cancer drug, paclitaxel, which are both derived from plants.
It seems that TCMs are already being backed into a corner. The Medicines and Healthcare Products Regulatory Agency of the United Kingdom announced in January it would seek public consultation over the review of a provision in the Medicine Act 1968, which will require a professional standard for TCMs, accountability of herbal practitioners, and plant medicines to meet European Union good manufacturing production (GMP) standards.
At present, very few Chinese TCM manufacturers hold EU GMP certificates while EU countries are the top destination of China’s TCM exports.
The TCM industry achieved sales of 114.01b yuan (US$14.73b) last year, recording profits of 10.42b yuan (US$1.35b). Profit growth for the year only reached 2.89% though, much lower than that of 2005, which was 8.85%.
However, if China’s maintains its push for TCMs as a complementary medicine, or continues its TCM modernization endeavors, the further building of standards such as GMP is necessary if Chinese manufacturers are to crack the international market and expand overseas.
One thing seems clear, all roads are leading in the one direction - towards the need for tighter standards.
Alternative medicine popular in Canada: survey
Fraser Institute - More than half of Canadians surveyed in 2006 reported using at least one form of complementary or alternative medicine or treatment during the previous year, according to a new report published today by independent research organization, The Fraser Institute.
The report, Complementary and Alternative Medicine in Canada: Trends in Use and Public Attitudes, 1997-2006, is based on a survey of 2,000 adult Canadians conducted in 2006. It follows up on a similar survey done in 1997.
The survey showed 54% of respondents used at least one form of alternative or complementary therapy in the year prior to the survey, an increase of four percentage points over the 1997 result of 50%.
“This increased use of alternative therapies is another indicator of Canadians’ desire to have more choice and control over their health care options,” said Nadeem Esmail, The Fraser Institute’s Director of Health System Performance and author of the report.
The most commonly used complementary and alternative medicines and therapies reported were massage (19%), prayer (16%), chiropractic care (15%), relaxation techniques (14%), and herbal therapies (10%).
Most users of alternative therapies said they did so to prevent future illness from occurring or to maintain health and vitality. Of those who used alternative medicine in the 12 months prior to the 2006 survey, 53% of respondents (down slightly from 56% in 1997) had not discussed their use of alternative medicine with their doctor.
On a provincial basis, Alberta saw the largest increase in the use of alternative therapies in the year previous to the 2006 survey (68% compared to 54% in 1997), followed by Ontario (55% compared to 50% in 1997), and British Columbia (64% from 60% in 1997). Quebec and Saskatchewan/ Manitoba both experienced a 1% increase, moving from 44 to 45 and from 58 to 59% respectively, while Atlantic Canada experienced a decrease in the use of alternative therapies, falling to 39% in 2006 from 45% in 1997.
Despite the increased use of alternative medicine, the majority of Canadians still consider medical doctors the main providers of health care with almost half of respondents in 2006 seeing a doctor before turning to a provider of alternative therapy. Additionally, a higher proportion of respondents saw a medical doctor for their condition regarding treatment for eight of the 10 most common medical conditions.
“These results show Canadians retain confidence in physicians. But since many of the most common problems Canadians suffer from are chronic – allergies, back or neck problems, arthritis and rheumatism – they require more than just symptomatic treatment. Consequently, Canadians are looking for alternatives,” Esmail said.
What is interesting, he added, is that most alternative and complementary treatments are not covered by government health insurance plans. Yet a large number of people choose those options.
“When it comes to health and well-being, a significant number of Canadians are willing to spend their own money.”
Esmail estimates that Canadians spent approximately $7.8 billion out of pocket on alternative medicine in the year before the 2006 survey — a significant increase from the nearly $5.4 billion (inflation-adjusted) spent in 1997. In 2006, more than $5.6 billion was spent on providers of alternative therapy, while another $2.2 billion was spent on herbs, vitamins, special diet programs, books, classes and equipment.
But the survey also shows the majority of Canadians (59%) believe that alternative therapies should be paid for privately, not by provincial health plans. The highest level of support for private payment came from the group that used alternative therapy the most: 58% of 18- to 34-year-olds used alternative therapies in the 12 months prior to the 2006 survey, and 62% of them preferred that individuals pay for it privately.
Regionally, support for private payment in 2006 was strongest in Quebec and Saskatchewan/Manitoba (66%) and weakest in Atlantic Canada (50%). This is a notable change from 1997 when support was strongest in Atlantic Canada (71%) and weakest in British Columbia (48%).
“In 2006, 74% of Canadians say they have used alternative therapies at some point in their lifetimes, and more than half of Canadians have used alternative therapies in the year prior to the survey,” Esmail said.
“However, there are some notable differences between the regions in Canada with respect to both use and attitudes towards alternative medicine. Albertans and British Columbians are more likely to see value in alternative therapies while skepticism reigns in Atlantic Canada. A national consensus on this issue is highly improbable.”
chinese medicine2/3 Chinese seniors in Canada use both TCM, Western medicine: study
CBC - A University of Calgary professor says doctors need to be more open-minded when it comes to traditional Chinese medicine because it’s used commonly among older Chinese immigrants.
Daniel Lai surveyed more than 2,000 Chinese immigrants aged 55 and over in seven major Canadian cities, including Calgary and Edmonton.
His results, published recently in the Family Practice Advanced Access Journal, found that two-thirds of Canada’s elderly Chinese immigrants are using traditional Chinese medicine in combination with the Western health-care system.
“Quite a significant number of them have used traditional Chinese medicine as a complementary way of maintaining their health or as a way of dealing with illnesses or diseases that they don’t find Western medicines as effective for them.”
Lany Woo, nearly 70 years old, is diabetic and has lung cancer. In addition to the usual insulin and chemotherapy treatments, Woo grinds a type of mushroom into a powder and boils it into a tea.
Woo is convinced the traditional Chinese medicine — in combination with regular doctors visits and drugs — is helping her health, improving her immune system and making her stronger.
Lai said his study shows many doctors are not listening to patients like Woo when they want to talk about alternative therapies.
“Very often family physicians do not know about the chemical reaction of combining various kinds of herbal medicine and Western medicine. I think there is definitely health concern to the patients.”
The best way for doctors to address the problem is to educate themselves and talk to their patients openly about alternative therapies, he said.
Few herb users check scientific backings
WebMD - About two–thirds of people taking herbal supplements to treat a health condition don’t check scientific guidelines, say University of Iowa researchers. Read more
Traditional Chinese medicine eases chemotherapy side effects
Earth Times - Traditional Chinese medicine could help ease the side effects of chemotheraphy for cancer patients, according to a study carried out by researchers in Taiwan, Hong Kong and China, media reports said Saturday.
“A chemotherapy regimen can last a few months and many patients experience nausea, vomiting and fatigue,” The Business Times quoted Dr Tony Mok Shu Kam, professor of clinical oncology at the Chinese University of Hong Kong, as saying. “For some people, it can get quite bad.”
Chemotherapy involves chemical agents to stop cancer cells from growing and is widely used in treatments.
Mok, who will speak on Sunday at British medical journal Lancet’s forum in Singapore, said the latest study involved breast and colon cancer patients.
“All the selected patients were seen not only by an oncologist but by a traditional herbalist, who then prescribed an individualized herbal recipe,” Mok told the newspaper.
Depending on a code known only to the pharmacist, the patient received either the recipe or a placebo, Mok said. The study successfully demonstrated that herbal remedies can help ease the side effects.
Mok’s study is the latest in a wave of herbal medical research triggered in China in the mid-1990s with the appearance of Kanglaite, a drug containing a herbal extract which is China’s top-selling cancer treatment, the report said. It’s use has not been approved outside the country.
Mok cautioned that traditional Chinese medicine alone cannot effectively treat cancer and should not be used as a primary mode of treatment. Herbal remedies play an auxiliary role by helping to relieve symptoms associated with treatments.
“While it is true many herbs may have anti-cancer properties, that’s not the same as saying these herbs can cure or treat cancer,” Mok told the newspaper.
What is needed are high-quality clinical trials on traditional medicine, Mok stressed.
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