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More Chinese Traditional Medicine, Unfortunately

I mentioned the other day that what was reported as a hydroxychloroquine trial in China may well have been (or at least begun as) a trial of “traditional Chinese medicine” (TCM). It doesn’t take much digging to turn up a number of registered clinical trials for coronavirus therapy via TCM, actually. Here are a few at, and while it’s harder to do a single search for the topic in the Chinese registry, I’ve found this, this, this, this, thisthis  this, and this. No doubt some of those overlap, but they’re also just a subset of a large number of TCM trials in general. I mentioned this issue in passing here, and have talked about the Chinese government’s attachment to TCM in the past as well.

But perhaps it’s time to talk about it again. I should make my general feelings clear right at the beginning: I have seen very little convincing evidence of efficacy for TCM overall, so the amount of money and effort being thrown at it is rather interesting. To forestall claims of anti-Chinese bias on my part, let me make clear that I have seen very little convincing evidence for Western traditional medicine, either. And by that I mean the herbal preparations that line the shelves of the pharmacies and health-food stores. The NIH has had a whole section devoted to alternative and complementary medicine for nearly twenty years now, and one of their mandates is to produce and review hard clinical evidence for these various therapies. My impression, and I’m happy to be corrected on this, is that there isn’t much. You can scroll through the list of the trials that have been run under the auspices of the agency without finding much to comment on, that’s for sure. And I don’t think the situation is much different on the Chinese side of things.

Now, it’s for sure that there are active compounds from natural sources – it hardly bears saying, since the entire history of medicinal chemistry and drug therapy starts with these. Quinine, morphine, digitalis, penicillin. . .you can go on and on. But note that all of these are active compounds, and the action of the initial natural-extract preparations were due to those active compounds which were then isolated and purified. The same goes for artemisinin, isolated from the Chinese herb qinghao. But that’s not what we’re seeing in all these TCM trials – nope, these are the good old-fashioned herbal preparations (or their modern commercial forms), treated as de facto medicines even if people have looked for active compounds in them without really finding much.

It goes further: this news item from Nature is about the Chinese government not just subsidizing the testing of these remedies, but actively promoting them as part of the country’s response to the epidemic. That earlier blog post has links to the ways that the government has been promoting TCM in other countries and punishing critics of it at home, and there is no sign of either of those efforts easing up. There are, in fact, reports of physicians being punished when speaking about these COVID-19 efforts Apparently the coronavirus can be fit into the TCM category of “diseases caused by noxious dampness”, so off we go. If you can stand China Daily, here’s one of their many articles on the subject. These preparations have the official blessing of the government and the regulatory agencies, and China has been sending them as donations to other countries. But as the Nature article mentions, the clinical evidence for them is very weak.

This isn’t a medical move; it’s a political one – the government is actively promoting a “Chinese response” to the epidemic as a model for other countries (an effort that’s meeting with mixed success). One form this takes is apparently active lobbying and influence within the WHO. As mentioned by Nature, the initial guidance from the WHO warned against herbal remedies for the coronavirus, but that language has since disappeared. It doesn’t take you long to find documents on the WHO web site extolling the stuff, either. As a separate but equally China-centric WHO issue, the agency said yesterday that it has “no mandate” to invite Taiwan as an observer to an upcoming world health summit, citing “divergent views” among member states. Frankly, Taiwan seems to have done an excellent job with the current pandemic and would likely be able to add to the discussion, but it’s not hard to see what’s happening here.

I’m not enjoying writing this blog post. There are a lot of useless and actively harmful things that can come from an overly nationalist approach, and that means not only the Chinese self-promotion, but also taking a public anti-Chinese stance in other countries just for the approval ratings. That is, in fact, one of the things that is worst about the current nationalist moment that we’re having in world politics; I strongly believe that there are far more wrong moves that can be made using that worldview than right ones. But facts remain facts. There is little or no reason to recommend traditional Chinese medicine against the coronavirus, and doing so just adds to the noise and confusion. We have way too much of both already.


80 comments on “More Chinese Traditional Medicine, Unfortunately”

  1. david says:

    You say “But as the Nature article mentions, the clinical evidence for them is very weak.” I think this is much too strong. I think with many of these herbal medicines, there is evidence that they have been doped with real drugs (e.g. ), that even if a herb has an active ingredient, there is no way of determining the dosage (as it varies plant to plant) and that it is frankly dangerous to take these things into your body.

    1. loupgarous says:

      In November 2018 FDA sent a warning letter to a nearby “herbal medicines” dealer for advertising its “dietary supplements” “Tianaa Red”, “Tianaa White”, and “Tianaa Green” as being good for depresssion on their web site. They were, under the Food, Drug, and Cosmetic Act, “unapproved new drugs” (no NDA, no clinical trials, no proof of safety and efficacy).

      FDA added that even if the labelling on those products omitted the claims of curing a disease, they were “adulterated” under the meaning of the Food, Drug, and Cosmetic Act, because they were spiked with tianeptine, an antidepressant not approved for that use here in the US, the UK, Australia, Canada, or New Zealand. Tianeptine’s reputation as an opioid agonist and nootropic means its some of its users wind up in emergency rooms here, anyway.

    2. johnnyboy says:

      I remember getting involved despite myself in a ‘trial’ (one without a control group of course) of some deer antler extract used to treat arthritis in dogs. Surprisingly a couple of dogs died suddenly not too long after treatment, and pathology showed their adrenal cortex was essentially gone – basically Addison’s disease, which is very rare in dogs. More likely, the extract had been spiked with massive amounts of corticosteroids in order to decreased joint inflammation, which had led to severe adrenocortical atrophy, and shock following termination of treatment. Certainly didn’t help change my mind on the benefits of ‘natural’ treatments.

      1. Metaphysician says:

        I lean to the following two ideas:

        1. Uncontrolled medical studies should be de facto breaches of experimental ethics, because they cannot provide any meaningful information to balance patient risk.

        2. Commercial claims and marketing based on uncontrolled studies should be de facto fraud, due to uncontrolled studies being functionally indistinguishable from no information.

        I admit, the problem is defining “controlled” in a way that allows for all legitimate controls that aren’t double blind placebo, but also doesn’t also provide trivially huge loopholes for bad actors.

        1. Jim Hartley says:

          The law makes those quality judgments all the time… I like your proposals!

  2. colintd says:

    Brings to mind the old joke:

    “What do you call alternative/complementary/traditional medicine that can be proven to work?”


    If China (or others) believe that TCM works, then they should fund large randomized trials conducted by independent organizations and independent personnel. Those things that can be shown to work, and stand-up under repeated testing, can become mainstream medicine. The rest should be discarded (especially the stuff with heavy metals).

    1. myma says:

      … and also those that use rare animal body parts. Those should be really and truly banned. There is a hypothesis that this epidemic is due to pangolins and their scales. I haven’t read the latest on that hypothesis whether it is holding up , but the pangolin trafficking is rampant and should be stopped regardless.

      1. Andrew Molitor says:

        If I was in charge of putting a lid on rhino horn (tiger spleen, whatever) poaching, whenever I caught some guys I’d let them go after spiking a couple of the horns with botulinum. I’d make it look like they bribed their way out of it.

        Sometimes the medicine helps with your erectile dis-function. And sometimes it just makes the world a better place.

  3. JustVisitin says:

    TCM was promoted by Chairman Mao because at the time he could not or did not want to invest in developing a standard medical system for the nation. He refused to use TCM himself, having a full suite of ordinary medicine practitioners on staff for his and his family’s use.

    The blog “Respectful Insolence” has hosted several rather incisive articles on the subject.

    1. tlp says:

      He couldn’t find plant-based barbiturates, I guess

  4. Barry says:

    When my father was in Med. School (early 1950s)pure, certified (toxic) digitalis was widely used in cardiac patients. But one of his professors remembered the era of prescribing dried foxglove leaves (some were still using them). He (the prescribing physician) would taste each batch and guess from the bitterness what the concentration of digitalis was, and how much therefore to prescribe. Given the scant therapeutic index for this one, it would never get through modern Clinical Trials

    1. Thomas says:

      I always understood it was to be tested with a frog’s leg. But maybe that is just lore.

      1. CM says:

        That’s just what Big Frog Leg wants us to believe

        1. Ken says:

          Can’t find the upvote button here, but you deserve one for making me laugh.

      2. Mark says:

        I remember (vaguely) pigeon emetic doses. Galenical mixtures of digitalis leaf were standardized by how much made a pigeon throw up.

  5. The 2015 Nobel Prize winner YOUYOU TU recognized 4,000-year-old Chinese studies. Isn’t so much said now about NITRICAL OXIDE? Among other things to inhibit the activation of the nuclear factor NF-kB? and help patients? Artemisinin is a natural product used as an alternative medicine in the treatment of severe and multi-resistant malaria. Artemisinin shares with other sesquiterpene lactones the ability to inhibit the activation of the nuclear factor NF-kB: by this mechanism, artemisinin, as well as parthenolide, inhibits the synthesis of nitric oxide in human astrocytoma T67 cells stimulated by cytokines. These results suggest that artemisinin, in addition to its antiparasitic properties, can also have a therapeutic effect on the neurological complications of malaria and consequently on Coronavirus in the host’s body. Who is wrong with taking tea or taking ARTEMISINE tablets?

    1. Hap says:

      But, with artemisinin, someone found out what worked and tested it in controlled trials (because anecdata is still anecdata, selected from the experiences of everyone who has taken them by that traitor memory). That’s why it got a Nobel.

      In contrast, if you say something cures everything, it probably doesn’t actually cure anything. Stupidity in the service of political ends is a cross-cultural phenomenon.

    2. James Brossard says:


    3. loupgarous says:

      The difference between tea from Artemisia annua and artemisinin in dosage form is that between a botanical said to work in herbalist tradition and the purified, concentrated active principle of the plant for which Tu Youyou was awarded the 2015 Nobel Prize in Medicine – for proving artemisinin was an effective treatment of malaria and establishing the effective doses for it. Hearsay (albeit 4000 years of hearsay) versus documented science.

      Artemisinin is part of the human scientific medical tradition, teas and herbs are not (unless their active principles have, like artemisinin, been purified, isolated, found to be effective in controlled studies, and safe and effective doses learned from clinical study). There’s no national science or medicine. Hitler and Mussolini denounced “Jewish physics”, caused the most of the inventors of nuclear physics and chemistry to flee Europe, and lost World War 2. Actual physics and chemistry won that war, along with selfless valor.

  6. What harm to the human body in chewing CRAVO DA INDIA, with CROWN (which has EUGENOL which is a great bactericide and fungicide?), Every 6 hours at most 4 a day, to try to kill the Coronavirus in the throat (where it like to replicate at very high rates) and help and clean the esophagus?

    1. sergei says:


      Eugenol tastes nice, though.

    2. FoodScientist says:

      Corona virus isn’t exactly fungal or bacterial in nature.

  7. Alan Goldhammer says:

    Homeopathic treatments still enjoy a cachet even in the US. We have a small apothecary near by that is happy to sell treatments in this area.

    1. emba says:

      That’s an understatement. Homeopathy and naturopathy are sold in *every major pharmacy* I go to (Walgreens, CVS, grocery stores etc.).

    2. Charles H. says:

      Ok. But the best non-prescription cough syrup I ever took claimed to be homeopathic. (Well, I wanted one that didn’t contain sugar, so that limited the competition.) But actually, it was as good as the ones containing sugar that I’d used in earlier years. And as good as a couple of the prescription ones.

      Now I don’t really think it was homeopathic, but that’s what it said on the label. I think it was a thick soothing syrup that soothed the back of the throat with a citrus flavor that wasn’t quite orange…but also wasn’t faint. Perhaps what they claimed as the active ingredient was only present as a trace…but I don’t remember the label saying so.

      So, this was a medicine that claimed to be homeopathic, but which worked. But which probably worked for reasons that have nothing to do with homeopathy.

      1. MagickChicken says:

        It definitely wasn’t homeopathic if it was a syrup, because as Derek mentioned below, homeopathic solutions are LITERALLY just water.

        When I was in grad school about 10 years ago at IU, I needed a mild sedative for my 6-lb blind cat for the road trip home over holiday, and as I was new in town, I just picked a random vet and walked in. The tech/receptionist said there wasn’t really time to squeeze me in, but that I should go down the street to Whole Foods (I had never heard of them at the time, which is why alarms didn’t go off) and pick up RxWhatever, because it worked great! I picked up a bottle while goggling at all the weirdos, gave the cat a healthy dose, got on the road and spent the next 3 hours listening to that poor beast wail and thrash in her crate, from which she actually managed to break free, and then pooped in the back window. When we finally got home, I pulled out the damn bottle and saw that it was a 200c (i.e., 10^400 times dilution in water) homeopathic solution. Needless to say, I was very pissed, but at least I understood why it didn’t work!

      2. emba says:

        The “real” cough syrup doesn’t have very much evidence behind it either.

    3. Adrian says:

      Homeopathy is not traditional medicine, it was invented by a German doctor 200 years ago based on a scientific theory that turned out to be incorrect.

      1. Derek Lowe says:

        A lot of people are confused about this – many believe that “homeopathic” is another way of saying “herbal”, and are quite surprised to find out that it’s Amazing Wonder Water instead.

      2. German Person says:

        And is, infuriatingly, covered by many major German health insurance policies.

        1. loupgarous says:

          While Britain’s National Health Service has recently refused to pay for homeopathic remedies, insisting logically that those who believe in their effectiveness prove it by paying for them out of pocket.

  8. Evid says:

    If you state that “the government has been promoting TCM in other countries and punishing critics of it at home” it would be wise also to investigate where their SARS-Cov2 really comes from…. many scientists trust easily the ‘evidence’ that natural Cov2 came from the market where you can buy also TCMs against Covid19 (were these TCMs also tested and found to be active in the Wuhan virology lab?!)

  9. Walter Sobchak says:

    Article discusses CTM connection:

    “Another Malaria Cure Draws Notice in Coronavirus Outbreak, This Time in Africa: Madagascar’s leader promotes use of extracts from artemisia annua, prompting orders from other countries on continent despite no evidence of success” | By Gabriele Steinhauser | May 12, 2020

  10. I have undertaken 9 blinded controlled trials on multi-component herbal products and have seen statistically significant results in every one. Most of the ingredients tested are used in TCM. One allergy season immune health product was tested in two blinded controlled crossover studies and showed significant (p<.001) results within 10 minutes with an increasing difference between treatment and placebo at every time point (10, 20, 30 45, and 60 minutes) using an objective measure of peak nasal inspiratory flow. But, looking for studies that show significance misses the larger point regarding TCM. The practice of medicine, any medicine, is two parts, diagnosis and treatment. It's the diagnosis that leads to effective treatment and TCM can provide insights that are not considered in western medicine. It's that diagnostic insight that lead to the development of a successful treatment of the immune system in allergic subjects.

    1. Derek Lowe says:

      Please provide some registration numbers for those trials so we can have a look. Thanks!

    2. MagickChicken says:

      Honestly, if there’s one place I *would* expect to see TCM work, it would be in allergy treatment. Your body reacts badly to grass, so you eat a bunch of grass to desensitize your body to it. Basically just allergy shots with a higher risk of adulteration concerns.

      1. MagickChicken says:

        (Not in a 10-minute window, though)

      2. As2O3 says:

        Ephedra is a commonly used herb in TCM…

    3. Academologist says:

      More impressive would be nine trials run by independent investigators who don’t have obvious conflicts of interest. An ethical researcher / physician would know better than to gloss over a financial stake they hold in the treatments they promote.

      Shame on you.

  11. David P says:

    I worry that nationalistic agenda actually reduce the attention paid to specific and very real threats such as this since they are swept under the category of “bellicose anti-X rhetoric”. If we can figure out how to make our political and national discourse more evidence-based, that has surely got to be one of the most health-enhancing interventions we can imagine…

  12. Daniel Barkalow says:

    “Traditional medicine” is great at getting placebo effects, which doesn’t do too badly as long as the substance isn’t harmful, there’s nothing better to do, and it’s cheap. My choice of traditional medicine is generally regarded as safe for all ages, and it’s $4/lb from the candy store. It might also reduce inflammation in the affected area, but it definitely reduces the amount of complaining about being sick in 7 out of 9 local residents, which is why I prescribe it. (Although it’s counterindicated for children under 13, who have an elevated risk of calling it “gross old-people candy”.) I think it is, on the whole, better than TCM, which many patients and caregivers find “really stinky”.

    1. SilverlakeBodhisattva says:

      Horehound? Salted licorice?

      1. Mammalian scale-up person says:

        I used to think my grandmother gave us kids horehound drops as a sort of test whether we were goldbricking to get out of school – if we were magically better when threatened with horehound drops and a cup of weak Lipton’s for breakfast, then we were fit to go to school. If we didn’t complain too much about the horehound drops, it was time to call the doctor.

      2. Marc says:

        I tried horehound once or twice when I was a kid, but literally remember nothing at all about the flavor – not even whether I liked it or not. The name stuck with me, though…

        Salted licorice, on the other hand: I tried it almost accidentally a couple of years ago (it was on sale at World Market; I like STRONG licorice and can hardly ever find it, so I tried it on a whim). At first I thought it was the worst thing I had ever tasted… but it sorta grew on me, and a few minutes later I had to try another piece just to see if it was as horrible as I’d thought at first. One thing led to another, and… I have a bag of Gustaf’s Double Salt in front of me at this very moment. I’m hooked.
        (For anybody who”s never tried it – the “salt” is NOT sodium chloride, but ammonium chloride, aka sal ammoniac. It tastes… surprising.)

  13. DTX says:

    During trips to China, I’ve been surprised at how often I’ve been asked “do you believe in Chinese medicine?” This is the exact wording (in English). Both technical professionals and those without a scientific background have asked me.

    Implicit in this question is that TCM is based on belief, not science. I answer it comfortably “Almost anything can be a drug, the key is knowing the safe & effective dose as well as the side effects.”

    ~ 5 years ago, the Chinese FDA (now called NMPA) announced a program to start measuring the amount of actives in TCM. The idea was that if you switch brands, you should be receiving the same amount of active. This caused much disagreement among Chinese who questioned whether you could actually measure active ingredients. One friend said “who knows really how TCM works???” I never heard if this program ever went forward.

    1. Tc says:

      TCM helps but does not work

  14. David says:

    It’s hard to fault China pushing TCM when the US is kindly helping out our own forms of quackery. Congress protected “nutritional supplements” from significant FDA regulation. And NCCIM (branch of NIH for alternative medicine) has two major missions: First, to subsidize sloppy studies that seem to produce hints of efficacy, with no replication in more rigorous followup studies. Second, to fund professorships at medical schools for alt-med enthusiasts who teach quackery to medical students. That’s a paraphrase of their actual mission statement (from their website), which is “We conduct and support research and provide information about complementary health products and practices.” But the information they provide is sloppy: for both accupuncture, chiropractic, and naturopathy, they don’t clearly state that there is no solid evidence that they work.

  15. Coincidental STAT article today:

    A secret experiment revealed: In a medical first, doctors treat Parkinson’s with a novel brain cell transplant
    Kim knew it would take tens of millions of dopamine neurons to have a prayer of helping a Parkinson’s patient. The recipe for turning undifferentiated iPS cells into dopamine neurons wasn’t perfect, however, which presented a problem: The remaining iPS cells can seed tumors.

    “Even after two or three weeks of differentiation, there can remain undifferentiated cells,” Kim said. If he turned 99.9% of iPS cells into dopamine neurons, that would leave 10,000 iPS cells. Hitting 99.99% would leave 1,000. How efficient was efficient enough? “We realized we needed to remove all of them,” Kim said.

    That meant looking for a killer. Kim and colleagues in South Korea pored over a database of compounds, searching for any that target a gene called survivin, which is abundant in iPS cells. They got a hit: quercetin. Testing the Chinese herbal compound on his iPS cells, Kim found, “if you treat the cells once, for 12 hours, while they’re differentiating, quercetin completely removes the undifferentiated cells.”

  16. Coincidental STAT article today (URL in the link):

    A secret experiment revealed: In a medical first, doctors treat Parkinson’s with a novel brain cell transplant
    Kim knew it would take tens of millions of dopamine neurons to have a prayer of helping a Parkinson’s patient. The recipe for turning undifferentiated iPS cells into dopamine neurons wasn’t perfect, however, which presented a problem: The remaining iPS cells can seed tumors.

    “Even after two or three weeks of differentiation, there can remain undifferentiated cells,” Kim said. If he turned 99.9% of iPS cells into dopamine neurons, that would leave 10,000 iPS cells. Hitting 99.99% would leave 1,000. How efficient was efficient enough? “We realized we needed to remove all of them,” Kim said.

    That meant looking for a killer. Kim and colleagues in South Korea pored over a database of compounds, searching for any that target a gene called survivin, which is abundant in iPS cells. They got a hit: quercetin. Testing the Chinese herbal compound on his iPS cells, Kim found, “if you treat the cells once, for 12 hours, while they’re differentiating, quercetin completely removes the undifferentiated cells.”

  17. Surfactrant says:

    Taiwan has done an outstanding job, I don’t think this is highlighted enough
    because of political considerations, which is unfortunate as hundreds of thousands
    of lives could have been saved by following the Taiwan CDC example.

    No new cases in weeks, less than double digit deaths.
    Everything is open and functioning.

    When compared to the illogical nightmare happening in the US,
    I feel like I’m living in a fantasy world.

    I came back to Taiwan in January
    Taiwan ~250 cases
    Seattle ~ 1-3 cases

    by April
    Taiwan ~440 cases (a large part of those infected Taiwanese returning home)
    US >1,000,000 cases – and talking of opening up?!!?

    1. intercostal says:

      I agree more attention should be paid to Taiwan, but I don’t think it’s fair to compare the outcome in Taiwan (or New Zealand or Iceland or any island nation) to the US.

      The US is huge and includes some areas that are very hard-hit and some that are barely affected. And it’s too large and too connected to the rest of the world, even now, for eradicating the virus to be plausible.

      Hawaii and other US islands may be able to eradicate the virus, though. Maybe even Alaska – I doubt there are many undocumented/clandestine border crossings from Canada.

      1. eub says:

        The thing is, even if the non-island countries had magically become islands say around Feb 1, it wouldn’t have changed their course materially. They were already seeded with the virus and they weren’t taking steps to survey or control its growth. Internal growth rate very soon outstripped influx across borders. The islands were seeded too, but they took steps. Possibly the idea of being an island helped them realize they didn’t just have to sit on their thumbs? or possibly they just paid attention. I say this as someone who dislikes Australia’s government politically, but they did their damn job.

        Taiwan absolutely deserves credit and should be listened to, but it’s the world’s failing that they haven’t drawn a line in the sand with China long ago: you don’t have to call them a country, but they’re going to be in the room. It really is somewhat above the WHO’s pay grade to apply pressure to China where the rest of the world hasn’t given them ground to stand on. The TCM PFD document is on them though.

        1. Some idiot says:

          I agree with you in part… I think the Australian Federal government has been quite lousy (although happily not nearly on the same scale as UK/US) in many ways, but that the states have been quite excellent.

          And yes, I think it is interesting in general to compare the states in Australia, as the seeding (and remoteness) varies considerably. I am pretty sure that there will be a lot of interesting stuff to read once the coals are raked over on this one…

          1. eub says:

            Ah, I hadn’t gotten into the details of the Australian response and which levels of government were doing what — I heard something sensible come out of Scott Morrison early on and may have overgeneralized.

        2. intercostal says:

          >>Possibly the idea of being an island helped them realize they didn’t just have to sit on their thumbs?

          That is kind of what I am thinking, in the sense that eradicating the virus seemed plausible even after community spread began, whereas it didn’t seem plausible in the US or mainland Europe.

          Taiwan/South Korea probably also benefited from experience with SARS and thus taking epidemics seriously, whereas the US hasn’t been really scared by an epidemic/pandemic in a very long time*. But I don’t think Iceland had SARS, so I think the island effect matters, even if it’s just “psychological” in the sense that the real difference is what policies a government considers seriously.

          Even if the US was an island, though, I don’t think eradication could work – it’s too internally heterogeneous and too big, and too politically divided. (Even with a different federal government, the states have a lot of public health power… something which I think is generally good and shouldn’t change, even if it’s imperfect right now.)

          *Except HIV/AIDS, but that’s a lot different from a respiratory disease, both in transmission and in how society views it. 2009-10 H1N1 was briefly scary but turned out to be much less bad than expected. There have been a lot of things that looked more or less like “false alarms” (West Nile virus around 2000, Ebola in Dallas in 2015, Zika in 2016, etc.) – not in the sense that they didn’t happen, but that the consequences were much less severe than media predictions at the beginning; so I think most people who weren’t infectious disease specialists or SF readers, etc. kind of thought that infectious disease was basically “over” / a non-threat in the US. (People just don’t bother to get flu shots, etc.)

          1. eub says:

            Some non-islands seem to have gotten it down too. Thailand, Vietnam (recent bump though), Cambodia — with SARS experience. Switzerland, Slovenia — I don’t know, all the Slovenes I know are pretty smart folks? There’s going to be a lot of history written.

          2. intercostal says:

            Possibly so.

            I don’t know enough about the governments/health systems of Vietnam, Thailand, or Cambodia to know whether their testing/reporting are likely to be reliable.

            Switzerland and Slovenia are probably not going to be able to completely get rid of it, even if they do way better than the rest of Europe, because it will just get re-introduced.

            Even countries like New Zealand and Iceland are likely going to have a problem with that eventually… there’s no way it’s going to be eradicated *worldwide* in a year or so, it’s probably going to become endemic after the pandemic ends, so unless they’re willing to do 14-day quarantines for everyone coming into the country *forever*, they will get it back eventually. But they might actually be able to do 14-day quarantines for everybody until there is a vaccine, if one is available on the more optimistic timeline, in about a year. I doubt that would work for mainland nations.

          3. intercostal says:

            (I’m not really as pessimistic long-term as that sounds, though. Once antibodies to it are common, either through past infection or vaccination, *endemic* (post-pandemic) COVID will probably be a lot less bad. I wonder if it will ultimately become another “common cold” coronavirus?)

          4. eub says:

            I can’t imagine how we’ll ever eradicate it worldwide now, but what Slovenia etc. have demonstrated that they can keep an introduction from exploding. What I would love to know more about is in each of these places, how much of the R reduction is due to drastic distancing, how much to relatively sustainable distancing, and how much due to better availability of test-trace-isolate. If it was just ability to CLOSE EVERYTHING that may have saved you once, but is useless against repeated leakage — and also against ongoing low-level circulation, which is really hard to eliminate 100%.

            There’s a mix of strategies people will be trying. If New Zealand finds they really are 100% free, they are likely going to try hard to hang onto that, with strict inbound quarantines. If it’s popping up here and there (the current South Korea experience, or China probably), you’re already dealing with that but you want to limit your numbers, so maybe you test everyone inbound and accept some false negatives in the mix.

            Yeah I don’t know much about Cambodia’s numbers’ reliability either, but if anybody’s downslope is due to systematic underreporting, that interferes with actual control and it’s soon enough going to run them into an exponential buzzsaw (as China did). Can’t bullshit a virus.

            No expert but it doesn’t look to me like our common-cold coronaviruses would have shown like this on a first introduction. Another beta HCoV strains (HKU1 2005) has been spotted while apparently low-incidence in the population, and hasn’t been seen to cause SARS-CoV-2’s rate of severe cases in older people. Granted that could be more similar antigenically to existing OC43 than SARS-CoV-2 is, I didn’t see from a quick look around.

          5. eub says:

            A big question about the future is how long any natural immunity lasts for. For the “common cold” HCoV strains, anti-spike seropositivity is high across age groups (linked from name). But they show reinfection in individuals and a corresponding flat age distribution for prevalence of viral RNA. Mutation selection in the virus, or ineffective antibody titer, or what? Virologist in the house?

  18. Tim Shi says:

    Glad to see people are talking about TCM in both Science (blog) and Nature (news). Let us recall a recently published Covid-19 Remdesivir clinical trial done by Chinese physicians (published by Lancet ). Expert commented this article was misinterpreted as demonstrating no benefit of a drug because the p-value did not meet an arbitrary threshold thus committing the “Absence of evidence is not the evidence of Absence”. Okay.
    Let to see TCM during 1918 Flu, there was another article published 2007 ( “The 1918 influenza pandemic infected nearly one quarter of the world’s population and resulted in the deaths of 100 million people. Most of the countries in the world were heavily impacted. What happened in China during this period? Compared with other countries, the severity of infection in China was relatively mild.” The published data were reported by local health authorities and international medical practitioners in China.
    It is a kind of real environmental comparison. My last point for all of you to comment, just leave any political opinion out of discussion, should we ask ourselves a simple question: why Chinese have less than 5,000 dead from Covid-19, comparing to American have more 81,000 dead from Covid-19?
    Any role of TCM for Chinese/ just ordinal patients? This is something need to dig out and think deeply.

    1. Ogamol says:

      I’ve heard verbal statements concerning the PRC leadership mandating a reduced count of Covid-19 infections, regardless of tests. I’ve read about other similar behavior by the PRC leadership here and in news articles. If having a strong Covid-19 recovery is important to the PRC leadership, why would they, in this specific case, tell the unvarnished truth?

    2. anon says:

      Probably because they were locked up for three months, while Americans were getting drunk at beaches.

  19. Anonymous says:

    There’s an episode of The Beverly Hillbillies where Uncle Jed pretends to be sick so Granny will feel useful. Jethro can’t find any stumpwater for her, so he just brings the whole stump in the kitchen. And Mr. Drysdale’s doctor orders his pharmacist to get Granny anything she needs. He doesn’t have good quality stumpwater, either. Or dried beetles.

  20. John Marlon says:

    After five years at the Guangzhou University of Chinese Medicine , I still have questions. Acupuncture is a different ballgame. So for those really curious , come to China, get a medical degree here, and see if your opinion changes. Yes, you will be required to study western medicine, TCM classes are in addition to typical medical school curriculum.

    1. K Frasier says:

      Ignoring TCM, is far worse than the biased rhetoric in some of this feed. My experience with TCM is proof enough for me. Using cough lung tonic to interfere with ACE2 recptors, naturally and safely is better than the nothing on offer now for COVID & flu as well really

  21. Frank says:

    “Traditional” Chinese medicine weaponized by “Western” Marxism, what an odd combination!

  22. chiz says:

    The first of the eight Chinese trials linked to is about IVF not covid 19.

  23. David Gosser says:

    From the NYS study. As indicated by respiratory (chest imaging, respiratory rate, O2 saturation) and hepatic (AST, alanine aminotransferase) measurements during the first 24 hours, patients in the treatment groups, particularly hydroxychloroquine + azithromycin, presented as having more clinically severe disease than the neither drug group. Ninety-five percent of the hydroxychloroquine + azithromycin group had abnormal chest imaging findings (top 3: air space opacity [63.0%], lung infiltrate [23.8%], and bronchopneumonia/pneumonia [20.7%])

  24. Tim Shi says:

    Hi, Derek, I respect your sincere opinion to discuss the TCM here, I submitted my opinion last night, but did not show up today. Of course you have full right to leave it or post it. This msg is a personal, you do not need to post it. I carefully review those above comments, honestly, it the 3rd grade level to know about TCM, even less knowledge than those medical professionals during 1918 global flu pandemic.


    1. Derek Lowe says:

      Your comment is up now – it landed in the spam folder because of the links.

      1. Tim Shi says:

        Derek, many thank and also apologized for my inpatient. IF there is a interesting in learning how TCM was working in treating Covid-19 Chinese patients (only focusing on clinical treatment and clinical trials), I can help to organize a virtual dialogue and invite the President of Chinese Academy of Chinese Traditional Medicine (Dr Huang Luqi) to share some of his personal view. it could bring this topic more real rather than words by words talking.

  25. Jonathan B says:

    Halfway through this medium post he refers to using PROTEOMICS TO IDENTIFY VACCINE INDUCED ALLERGIES early, and thus shorten the clinical trial timelines needed to assess candidates. What is meant by this exactly? Is it feasible/are we close to this kind of technology? What about antibody-dependent enhancement? Just an undergrad here, would appreciate your expert opinions.

  26. milkshake says:

    western traditional medicine – Some 20 years ago, I tried St John’s wort as a supplement, to improve my mood. It was an extract in capsules and I took only the recommended dose. Within two days my eyes were hurting like hell, I could not go out without sunglasses and I had difficulty reading from a piece of paper in a well-lit room. It turns out I was ingesting photo-toxic doses of hypericin that were causing inflammation of my retina. And this side effect was not even mentioned on the packaging! They just upped the concentration of their extract, to reach some level of hyperforin they advertised, without bothering to check the hypericin content in their stuff… This tells you how much quality control and expertise there is, in the dietary supplements arena. FDA puts very few limits on what can be put into these “herbal supplements, and does no quality checks whatsoever on the manufacturers – it may take a closer look at these “supplement” pseudo-medications only after there have been serious complaints, after few people ended up in hospital or dead.

  27. Carl Pham says:

    Real medicine is traditional medicine with all the bullshit magical thinking scraped off, just like real chemistry is alchemy with all the astrological hocus-pocus con-game attributes scraped off.

    One has to assume if you are particular interested in the the husk, after real medicine has extracted what’s valuable for healing, that you are especially interested in the flim-flam con artist aspects that are concentrated in the bran, so to speak.

  28. And you didn’t speak to one licensed acupuncturist here in the United States. Traditional Chinese Medicine is not just animal horns and disgusting parts. We have an established system here in the U.S., with schooling, licensing as well as higher standards for patient safety and increasing research. I understand your concern for the Chinese government to propagandize TCM but the dismissal the entire system of medicine is not warranted.

  29. Alan Tillotson says:

    It’s almost like the people who write these blogs don’t bother to check on PubMed

    Here is just the first on the list of 75,000 articles on Traditional Chinese Medicine if you search that term

    And for people who don’t believe in herbs as medicinal substances, I suggest you skip food one day and just drink coffee and eat prunes

    Int Immunopharmacol. 2020 May 12;84:106570. doi: 10.1016/j.intimp.2020.106570.
    Cinnamaldehyde suppresses NLRP3 derived IL-1β via activating succinate/HIF-1 in rheumatoid arthritis rats.

    Liu P1, Wang J1, Wen W1, Pan T1, Chen H1, Fu Y1, Wang F2, Huang JH3, Xu S4.
    Author information
    Cinnamaldehyde (CA) is an essential component of cinnamon (Cinnamomum cassia Presland), which is often used as a flavoring condiment in beverages, pastries, perfumes, etc. Cinnamon is also used as herbal medicine in China and Southeast Asia to treat rheumatoid arthritis. However, the molecular mechanism is unclear. In this study, we aim to investigate its anti-inflammatory effects against Rheumatoid arthritis (RA) using activated macrophages (Raw246.7) in vitro and adjuvant arthritis rats (AA) in vivo. The results demonstrated that CA significantly reduced synovial inflammation in AA rats, possibly due to suppression of the expressions of pro-inflammatory cytokines, especially the IL-1β. Further investigation found that CA also suppressed the activity of HIF-1α by inhibiting the accumulation of succinate in cytoplasm. As we know, the reduction of HIF-1α nucleation slows down IL-1β production, because HIF-1α activates the expression of NLRP3, which is involved in the assembly of inflammasome and processing of IL-1β. In addition, CA also inhibited the expression of the succinate receptor GPR91, which in turn inhibited the activation of HIF-1α. In conclusions, our results suggested that CA might be a potential therapeutic compound to relieve rheumatoid arthritis progress by suppressing IL-1β through modulating succinate/HIF-1α axis and inhibition of NLRP3.

    1. Lane Simonian says:

      It really does not matter how many studies or clinical trials you point people to, because in the minds of some natural products can never be used to treat any disease. Any study or clinical trials in which a particular natural compound or compounds does not work is used as proof that no natural compound can work. Any study or clinical trial that shows the opposite has to be deeply flawed.

      One of the very early study results for artemisinin for the novel coronavirus is scheduled to be out by the end of this month. I expect that this one at least has a shot.

    2. Simona says:

      I wonder how many of these articles have been produced by paper mills similar to the ones Elizabeth Bik and Leonid Schneider wrote about.

  30. Eric Orr says:

    Several of the data mining for useful substances against COVID identified Lycorine as a target. There was also a paper showing how Lycorine was very effective against multiple coronavirus’ including SARS and MERS in vitro and in an animal model.

    Also to give it up for traditional western and African medicine Lycorine may be useful in a bunch of diseases. It is iirc one oF the more violent emetics and just general all around bad poisonings one can have the misfortune to experience and at therapeutic levels would likely have some quite nasty side effects.

    In many ways not that much different from that other recent revival of traditional western medicine in colchicine. As person plagued by gout quite often who has had the pleasure to experience that he’ll drug it can go right back to the dark hole it came from and be left to the Biochem people who find it useful for whatever’s reason in their little Petri dishes.

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