What Could This Mean for Threatened Wildlife?
Originating in ancient China and dating back more than 2,500 years, Traditional Chinese Medicine (TCM) has continued to evolve with practitioners encompassing a variety of different practices including acupuncture, Chinese herbal medicine, moxibustion (burning an herb above the skin to apply heat to acupuncture points), and qi gong (combining specific movements, coordinated breathing, and mental focus). Based on theories of vital energy, TCM uses the flow of that energy along meridians in the body to maintain health. Compared to Conventional Western medicine, TCM focuses on the healing of the individual and some experts claim drawing conclusions from large groups (i.e., randomized, controlled clinical trials) can be very difficult. Remedies given by TCM practitioners are often a mix of herbs or animal parts to treat and help prevent health problems.
Historically, Traditional Chinese Medicine has most commonly been practiced in China, Japan, and Korea. However, over the past few years, China has been aggressively promoting TCM internationally with hopes to gain profit from the industry that is estimated to be worth more than $60 billion a year. Xi Jinping, China’s current president, strongly supports TCM and helped develop a national strategy promising universal access by 2020 and becoming a “booming” industry by 2030. Earlier in 2018, China State Media reported that 57 traditional medicinal centers were in development in places such as Poland, the United Arab Emirates, Germany, and France. These centers will provide TCM medical services and education with China hoping the new centers will help spread the influence of TCM globally. Known as China’s Belt and Road trade initiative, the endeavor has shown to be successful thus far with sales of TCM herbal medicines and other related products increasing 54% from 2016 to 2017 alone, totaling $295 million.
Traditional Chinese Medicine is currently making headlines in particular because of a connection the practice has made with the World Health Organization (WHO), a specialized agency of the United Nations particularly concerned with international public health. Entrusted under WHO, the International Classification of Diseases (ICD) is the foundational document for the identification of health trends and statistics globally, as well as the international standard for reporting diseases and health conditions. This reference source influences physicians with diagnoses, insurance companies with determining coverage, and health officials with interpreting mortality statistics. The ICD includes all the international codes for medical diagnoses and is currently in the drafting stage for its 11th revision.
For the first time in history, the ICD will include traditional medicine diagnoses in its instrumental medical compilation owned by the World Health Organization, consequently expanding the reach of these practices. For Traditional Chinese Medicine to get to this pivotal point, it took many years of intricate work coordinated by a man named Choi Seung-hoon. Starting in Beijing back in 2004, Choi worked to get a few dozen representatives from Asian nations to help consolidate thousands of years of traditional medicine into one classification system. This was no easy feat, for practices varied among the different regions and most countries wanted to make sure their preferred version was featured in the directory. But after many years of doctors meeting and debating, an agreement was finally made on a list of 3,106 terms including adopted English translations for these terms. This work accomplished by Choi’s committee will be in Chapter 26 of the ICD.
Choi and other experts believe this inclusion will without a doubt speed up already accelerating TCM practices around the world. Lixin Huang, Executive Director of the American College of Traditional Chinese Medicine at the California Institute of Integral Studies, thinks this is a positive step for recognizing TCM as a medical option to help people. The most recent document will be submitted to the executive board this month and then adopted at the World Health Assembly in May. The additions will include more than 400 codes pertaining to traditional medicine and describing a patient’s condition. WHO believes by incorporating TCM into the catalog, this will help meet the agency’s goal of having actual universal health care. The organization also thinks it is essential to include traditional treatments because they are often less costly and more accessible than Western medicine in certain countries.
Conversely, what may be less costly for humans, may end up costing the survivorship of many endangered species of animals. Chris Shepherd, Executive Director of Monitor (a British Columbia-based organization combating illegal wildlife trade) stated, “It’s no coincidence that the species most sought after with the TCM trade are the most critically endangered species.” Conservationists are worried that the new WHO decision paired with the overall growing popularity of the practice may have detrimental impacts on many species of animals. Cathy Dean, CEO of Save the Rhinos, made a compelling point stating, “It would be totally wrong if respecting the cultural beliefs of one country, China, lead to the extinction of Africa’s biological heritage.” She hopes WHO “will take a strong line against the use of animal products, let alone those from endangered species.”
Because the ICD can be modified “based on scientific evidence and needs from the field,” environmental organizations are pushing decision makers to take a second look to spell out caveats around what wildlife could or should be used. WHO spoke with National Geographic stating how including internationally comparable data on such diagnoses would be a good thing in that it would provide a basis for conducting further research and evaluation of their effectiveness. Gregory Hartl, a spokesman for WHO, emphasized that the inclusion of TCM into the ICD does not mean it is a recommendation of any given treatment’s efficacy. Inclusion is about acknowledging that a disease or symptom exists and that it should be measured. Furthermore, Hartl stated, “It does not mean we recommend or condone the use of animal parts such as rhinoceros horns: WHO recommends the enforcement of CITES, which protects rhinos, tigers, and other species.”
Although it is positive and necessary that WHO stands behind CITES, Shepherd shared how even though endangered species have protection, the black market still flourishes. It is estimated that total revenues from wildlife trafficking are up to $23 billion a year, ranking wildlife trafficking as the world’s fourth-most-profitable illegal trade after drugs, weapons, and human trafficking. There is overwhelming evidence on how pangolins are considered one of the most trafficked mammals in the world despite being barred from international trade by CITES. TCM believes pangolin has uses such as aiding nursing mothers’ lactation, controlling asthma, and even treating cancer. (For more overall information on this incredible animal, check out IFCNR’s blog post “Pity the Poor Pangolin.”)
Not only are conservationists concerned about the global spread of TCM, but also many Western-trained physicians and biomedical scientists are expressing alarm. These critics bring up valid points on the lack of robust scientific evidence for any effectiveness. Although there have been a few cases where TCM treatments proved effective in a randomized controlled clinical trial, scientists have spent millions of dollars on randomized trials showing very little success. One of the most comprehensive studies conducted by researchers at the University of Maryland School of Medicine surveyed 70 systematic reviews measuring the efficacy of TCM. They determined that no conclusion could be made on any of these reviews because the evidence was lacking or too poor in quality.
Those advocating TCM believe there are plenty of ways to prevent the harm of vulnerable species and also speak of the need to modernize and standardize the practice. The World Federation of Chinese Medicine Societies removed rhino horn and tiger bone from its list of approved products for patients over 20 years ago while also providing substitutes for those animal products for proper treatment. A TCM expert named Steve Given stated that with substitutions in TCM, it is often not a one-to-one swap and usually involves multiple different products to achieve the same effect. He also believes it is crucial that practitioners of TCM find alternatives and use them to help prevent species from going extinct.