China is promoting coronavirus treatments based on unproven traditional medicines
Scientists say rigorous trial data are needed to show that remedies are safe and effective
The Chinese government strongly encourages traditional medicine as a treatment for VIDOC-19. These remedies, which are an important part of the Chinese health care system, are even sent to countries such as Iran and Italy as part of international aid. But foreign scientists say it is dangerous to support therapies whose safety and effectiveness have not yet been proven.
There is currently no proven treatment for the fatal respiratory disease caused by the new coronavirus, although many countries are testing existing and experimental drugs. So far, only one of them - remdesivir, an antiviral - has been shown in randomized controlled trials to accelerate recovery.
In China, senior government officials and state media are claiming that a series of traditional Chinese medicines (TCMs) are effective in relieving the symptoms of VIDOC-19 and reducing deaths from the disease. However, there are no rigorous test data to demonstrate that these remedies are effective.
Although the effectiveness of some TCM remedies for COVID-19 is being tested, some researchers argue that the trials have not been rigorously designed and are unlikely to produce reliable results. Government officials and TCM practitioners believe that these remedies are safe because some have been used for thousands of years, but significant side effects have been reported.
"We are dealing with a serious infection that requires effective treatments. For TCM, there is no solid evidence, so its use is not only unwarranted, but dangerous," says Edzard Ernst, a retired complementary medicine researcher based in the UK.
Other world leaders have promoted unproven treatments for COVID-19. U.S. President Donald Trump has promoted the use of hydroxychloroquine, an antimalarial drug with significant potential side effects, whose effectiveness against COVID-19 is still under investigation. And the President of Madagascar, Andry Rajoelina, also said an herbal drink can cure people with COVID-19.
But the claims of these leaders have been criticized by scientists in their country. By contrast, in China, criticism of traditional Chinese medicine is moderate. The industry is worth billions of dollars a year and receives aggressive government support.
Harmful humidity
TCM is based on theories about qi, considered a vital energy that helps the body maintain health. Zhang Boli, president of the Tianjin University of Traditional Chinese Medicine and a member of the national team in charge of the Chinese response to the coronavirus epidemic, said serious cases could be attributed to "harmful humidity", which can cause qi to stagnate.
In March, TCM remedies were some of the treatments recommended by the Chinese Ministry of Health for COVID-19, and included a few dozen pills, powders, injectable therapies and recipes for making herbal teas, known as decoctions.
According to China's state media, the National Administration of Traditional Chinese Medicine claims that three formulas and three drugs "proved" to be effective in treating the disease. The China Daily reported that "comparative experiments" showed that a group of people who took COVID-19, herbal granules developed to combat H1N1 in 2009, recovered faster than those who had not taken the capsules, and tested negative for the new virus more than two days earlier. No further details were provided. Another comparative study described in the China Daily reported that injections of Xuebijing, a concoction of five plant extracts that is supposed to "detoxify and remove stasis from the blood", reduced the mortality rate of patients with severe illness by 8.8% when combined with standard drugs.
Huang Luqi, a TCM practitioner and director of the Chinese Academy of Medical Sciences in Beijing, says that starting in January, he conducted trials on three other TCM remedies to treat VIDOC-19 and found them to be safe and effective. On the clinical trials website in China, the treatments are described simply as traditional Chinese medicine. According to the site, one of the remedies is intended to treat the symptoms of VIDOC-19, another to prevent mild cases from becoming severe or critical, and a third to reduce the time it takes a patient to test negative for the virus. Mr. Huang did not respond to requests for further information, but indicated that the results will be published soon.
Other scientists say there is no convincing evidence that these remedies are effective against COVID-19. Although the trials had control groups, practitioners and patients do not appear to have been blinded to the person receiving the experimental treatment. Double-blind trials are the gold standard for evaluating the effectiveness of a treatment. "Unless evidence is provided, it is unethical to market TCM methods with claims of effects," says Dan Larhammar, a cell biologist at the University of Uppsala in Sweden.
Something is not necessarily better than nothing
People's faith in complementary medicine is understandable given that there is no agreement on what works against COVID-19, says Paul Offit, an infectious disease researcher at Children's Hospital in Philadelphia, Pennsylvania. But suggesting that people try alternative medicines could hurt, he says. "People think it's better to do something than to do nothing. History tells us that's not true.
Several of the "decoctions" promoted by the Ministry of Health's official COVID-19 treatment guidelines include a herb called ephedra, which contains the stimulant pseudoephedrine. Extracts of this plant containing this substance have been banned in the United States and several European countries after a series of deaths in the 1990s and 2000s among those who used it to diet or to improve their energy.
Ernst says that without clear evidence of the effectiveness and safety of these treatments, China should not send them to other countries.
"You have to prove the effectiveness of all the elements of a package," he says. Although TCM is a very important export product for China, its promotion during the pandemic "seems reckless and dangerous," he says. China has also sent masks and other protective equipment and fans to many countries, including the United States, and has contributed $50 million to the World Health Organization (WHO) for its response to COVID-19).
WHO initially discouraged the use of traditional remedies to treat VIDOC-19. During the early months of the epidemic, they were listed on the agency's website as "not effective against COVID-2019 and may be harmful".
Since then, the advice has been updated and the warning removed. A WHO spokesperson, Tarik Jašarević, says the initial statement "was too broad and did not take into account the fact that many people turn to traditional medicines to relieve some of the milder symptoms of COVID-19". According to Jašarević, the guide points out that there is no evidence that any current medicine - traditional or otherwise - can prevent or cure the disease, and that the WHO does not recommend self-medication with any substance as a prevention or cure for COVID-19.
Criticism of China's support for TCM treatments for COVID-19 is unlikely to spread within the country. In late April, a doctor at a hospital in Hubei province was censured and demoted from his administrative duties after posting online that China's recommendations on COVID-19 treatments, particularly TCM remedies, were not based on science. The doctor told Nature that he could not be interviewed on the subject.
