The contribution of traditional Chinese medicine to sustainable development: Keynote address at the International Conference on the Modernization of Traditional Chinese Medicine
Dr Margaret Chan
Director-General of the World Health Organization
Honourable ministers, distinguished participants, experts in traditional Chinese medicine, ladies and gentlemen,
Every country in the world, including an advanced nation like Singapore, needs to be concerned about the sustainability of its health services.
Population ageing is now a universal trend, affecting rich and poor countries in every region of the world. The globalized marketing of unhealthy products has made chronic noncommunicable diseases, like heart disease, cancer, and diabetes, the leading killers worldwide.
Economic growth and modernization, long associated with better health, are now creating conditions that leave more and more people living longer, sicker lives.
Most technology markets, like those for flat screen TVs and hand-held electronic devices, produce products that are progressively cheaper and easier to use. Not so for pharmaceuticals and medical devices, where new products are nearly always more expensive and more complex to use, often requiring specialized training.
Even the richest countries in the world cannot afford new treatments for common conditions like cancer and hepatitis C that cost from $50 000 to $150 000 per patient per year.
This trend is the opposite of sustainable development.
At the same time, a growing number of countries are reforming their health systems with the aim of reaching universal health coverage, which is a key target under the Sustainable Development Goal for health.
In other words, countries are seeking to expand coverage with essential services at a time when consumer expectations for care are rising, costs are soaring, and most budgets are either stagnant or reduced.
Faced with this dilemma, and most especially the costs of treating lifestyle-related chronic diseases, many experts see a need to shift the model for health service delivery away from a strictly biomedical model, focused on individual diseases, towards a more holistic approach.
This is an approach that stresses prevention as well as cure, offers integrated services that address the multiple determinants of health, and asks people to take more responsibility for their own health.
Apart from the need to do more for prevention, some countries are looking for approaches that stop people with minor complaints from flooding waiting rooms at clinics and in emergency wards.
In Europe, for example, pharmacists are trained to deal with common aches, pains, sniffles, and other complaints. They focus on symptoms, not diseases, and dispense over-the-counter products, including herbal remedies, to address these symptoms. In other words, they act as gatekeepers.
This is one way to reduce the burden on health services. Traditional Chinese medicine is another.
The World Health Organization welcomes this landmark conference on the modernization of traditional Chinese medicine. You seek, in particular, to give traditional medicine an evidence-based place within a health care system where mainstream modern medicine dominates.
Your agenda says many things. You are looking at China’s experiences in clinics and hospitals where traditional and modern medicine offer integrated services, at the role of health services and policy research, and the use of biomedical knowledge to modernize traditional Chinese medicine.
You are considering how more rigorous testing can meet the scientific standards needed for international recognition and acceptance. You are looking at the absolutely critical issue of safety, as demonstrated in well-designed clinical trials.
You are also looking at the performance of traditional Chinese medicine for specific indications, including digestive disorders, and giving attention to the two forms of traditional medicine most often used in modern health systems, namely acupuncture and herbal remedies.
All of these approaches can contribute to the modernization of traditional Chinese medicine.
I am Chinese, and I have used traditional Chinese medicine throughout my lifetime. I have no doubt that these preparations soothe, treat many common ailments, and relieve pain.
But if I have a bad toothache, I go to the dentist.
Ladies and gentlemen,
One approach when exploring the modernization of traditional Chinese medicine is to look at the shortcomings of modern medicine, both real and perceived. Paradoxically, these shortcomings have created a situation where traditional medicine meets a perceived need, yet earns a bad name at the same time.
In wealthy countries, the public often reacts in a negative way to health care that is seen as over-medicalized and over-specialized, with the patient treated like a collection of specialized body-parts on an assembly line, instead of a whole person.
People want more control over what is done to their bodies. They want to self-regulate their own health.
As seen in the movement of vaccine refusal, science is often mistrusted, sometimes even vilified. Rumours spread via social media can carry more weight than hundreds of well-designed peer-reviewed research studies.
People are suspicious that powerful new drugs may have side effects that have either not yet been detected or were never honestly disclosed.
Some analysts attribute this dissatisfaction and mistrust to the system, the infrastructure, the training, the incentives, and the orientation of modern medical care.
In many countries, this system dictates that a doctor spend no more than around 20 minutes with each patient. In many outpatient clinics for primary care, the time spent with patients is 5 minutes or less.
During these few minutes, the doctor is expected to act, not talk, to order medicines, tests, and other interventions. This practice contrasts sharply with the approach used by traditional practitioners.
Moreover, the number of doctors practicing family medicine continues to shrink dramatically in favour of more, and better-paid, specialists and sub-specialists.
Family physicians are a vanishing profession right at the time when the rise of noncommunicable diseases makes their skills essential for prevention and the continuity of sometimes life-long care.
The phenomenal rise of the alternative medicine industry responds to some of these shortcomings in what modern medicine has to offer. In several North American and European countries, the production and sale of herbal medicines, dietary supplements, and other so-called “natural” products have become a huge and profitable industry, amounting to $32 billion a year in the USA alone.
The industry fiercely defends its territory, its claims, and its profits. Aggressive marketing that makes unsubstantiated claims has antagonized many in the medical establishment.
As medical professionals argue, most alternative medicines are introduced onto the market, via over-the-counter sales or the internet, without any regulatory oversight.
These arguments point to the critical contribution regulatory authorities can make to the modernization of traditional Chinese medicine. A drive aimed at licensing and regulatory control can bring legitimacy to traditional remedies, as has been done here in Singapore.
Singapore has also pioneered some good policies that protect against some perceived dangers of traditional Chinese medicine. For example, patients are referred for traditional treatments, like acupuncture, by doctors trained in Western medicine.
Having a doctor's opinion as backup helps protect against the risk that what may seem to be uncomplicated complaints might actually be the early signals of a more serious condition.
Ladies and gentlemen,
Traditional Chinese medicine has many critics. Their criticisms must also be addressed if traditional Chinese medicine is to perform a legitimate role as an integrated part of a health system.
Some critics dismiss the entirety of this ancient art as nothing but pseudoscience, or "snake oil" medicine. They argue that the differences between East and West can never be reconciled.
They point out that few well-designed studies, following the gold standard of randomized controlled clinical trials, have demonstrated efficacy over placebos. They point to a lack of plausible and proven biological mechanisms through which traditional remedies exert their effects.
They point to the difficulty of standardized quality control, especially since the chemical composition of a plant species can vary according to where it was grown and in what type of soil, and when and how it was harvested.
The Western approach to testing is to isolate the active ingredients and test them one by one.
This, say proponents of traditional Chinese medicine, is part of the problem. It is not a single chemical responsible for the effect, but rather how multiple ingredients work in concert.
The Western approach to testing also denies the strong cultural and psychological component that is an integral part of the art of traditional medicine. Looking at individual chemicals is reductionist. It is like expecting a tree to grow without its roots.
As proponents note, the scientific method was not designed to accurately evaluate the full human experience that occurs when traditional medicine is delivered by skilled, experienced, and trusted practitioners in its cultural and historical homes.
Controlled clinical trials can evaluate the intervention or the herbal product, but not the full experience.
Moreover, complaints of pain, anxiety, and stress nearly always have a subjective dimension. The placebo effect is a well-documented scientific phenomenon.
As Nobel laureate Elizabeth Blackburn reminds both sides of the debate: “We tend to forget how powerful an organ the brain is in human biology.” Scientific research on the physiological effects of mental stress confirms the validity of that reminder.
Evidence is mounting that diet, exercise, no tobacco, limited alcohol, and stress reduction can do a better job of preventing or delaying the onset of heart disease than most drugs and surgical procedures.
Here, traditional Chinese medicine excels. It pioneered interventions like healthy and balanced diets, exercise, herbal remedies, and ways to reduce everyday stress.
Countries, like Singapore, aiming to integrate the best from traditional and modern medicine would do well to look not only at the many differences between traditional and modern medicine. Instead, they should look at those areas where both converge to help tackle the unique health challenges of the 21st century.
The fact that the 11th revision of the International Classification of Diseases, which is overseen by WHO, contains a chapter on traditional medicine is significant.
The chapter sets out diagnostic categories based on traditional medicine conditions which originated in ancient China and are now commonly used in China, Japan, the Republic of Korea, and Singapore.
Particular attention is being given to testing of the chapter in integrated health care settings in target countries where both traditional and Western medicine are practiced.
This innovation also bodes well for the modernization of traditional Chinese medicine as a contribution to universal health coverage that can be sustained, despite rising health care costs.