If there’s one thing that many advocates of quackery, be it practiced on its own or somehow “integrated” into medicine to produce that bastard offspring of a specialty known as “integrative medicine,” have in common, it’s a sense of persecution. If you read sites dedicated to alternative medicine, it won’t take you long to find claims that big pharma, the FDA, the CDC, or the AMA are Keeping Cures From The People. Even the more “respectable” advocates of quackery, the ones who promote “integrating” it into medicine, have a definite persecution complex. Take, for instance, John Weeks, who once attacked critics of the $200 million gift by Susan and Henry Samueli to the University of California, Irvine as having “blood on their hands.” Of course, this persecution complex is strategic, because advocates of pseudoscience in medicine love to portray their favored treatments, indeed their very existence, as a threat to conventional medicine, and what better indication that conventional medicine is threatened than its reacting by persecuting representatives of that threat. All one has to do is to consider the case of Tan Qindong.
It turns out that there is real persecution going on, but that persecution is not what advocates of, say, traditional Chinese medicine (TCM) think it is. From Nature a couple of weeks ago (and I can’t believe I missed this when it was first published):
A Chinese doctor who was arrested after he criticized a best-selling traditional Chinese remedy has been released, after more than three months in detention. Tan Qindong had been held at the Liangcheng county detention centre since January, when police said a post Tan had made on social media damaged the reputation of the traditional medicine and the company that makes it.
On 17 April, a provincial court found the police evidence for the case insufficient. Tan, a former anaesthesiologist who has founded several biomedical companies, was released on bail on that day. Tan, who lives in Guangzhou in southern China, is now awaiting trial. Lawyers familiar with Chinese criminal law told Nature that police have a year to collect more evidence or the case will be dismissed. They say the trial is unlikely to go ahead.
The episode highlights the sensitivities over traditional Chinese medicines (TCMs) in China. Although most of these therapies have not been tested for efficacy in randomized clinical trials — and serious side effects have been reported in some — TCM has support from the highest levels of government. Criticism of remedies is often blocked on the Internet in China. Some lawyers and physicians worry that Tan’s arrest will make people even more hesitant to criticize traditional therapies.
Of course, that’s the idea. So what was it that got Tan Quindong in trouble with the Chinese government? He wrote a post about a TCM remedy called Hongmao liquor, a best selling concoction of over 60 kinds of medicinal herbs and animal products that is registered as a nonprescription medicine. Advertisements for the liquor appeared frequently on Chinese TV and in other media and touted it as a treatment for basically anything that ails you, including painful joints, frail kidneys, spleen ailments, stomach problems, anemia, and basically dozens of ailments. Indeed, one Chinese story noted that Hongmao Pharmaceutical “overtook Procter & Gamble as China’s biggest advertiser by advertising budget in 2016, spending 15 billion yuan (about $2.2 billion at the time) that year. Hongmao Liquor isn’t cheap, either. For instance, a 500 mL bottle of the concoction costs around $100. There’s very little in English on the liquor or what it’s used for that I could find using Google, but it basically sounds like a witches’ brew of herbal extracts and various animal products in an alcohol base. I also found out that it’s marketed to the elderly primarily, but not just the elderly.
It’s popular, too, the second best-selling TCM remedy in China in 2016, when sales of Hongmao liquor reached 1.6 billion yuan. It was approved to be sold in licensed TCM shops and by licensed physicians in 1992 and became over-the-counter in 2003.
So were’s what got Dr. Tan into trouble:
Dr. Tan never expected such a ruckus after he published his essay criticizing Hongmao in December. He initially shared his views on a blog, which he said only a few fellow doctors read. He then spread it on WeChat, a popular Chinese social media service, where it was viewed more than 2,000 times, according to the police.
But the title of Dr. Tan’s article was eye-catching: “China’s miracle liquor, ‘Hongmao Medical Tonic,’ a poison from heaven.” Dr. Tan argued that the supposed curative effects of the 67 ingredients said to be used in the alcohol-based elixir were unclear at best, and could be dangerous for people with high blood pressure or diabetes.
Dr. Tan sounds like a man after Orac’s cybernetic heart, particularly his…Insolence. Be that as it may, what we have here is a doctor and entrepreneur writing an article critical of a TCM product as unproven and potentially unsafe for patients with hypertension or diabetes on a blog and a social media outlet where it was unlikely to have been read by more than around 2,500 people. The New York Times reports that the essay had little effect at first and went basically unnoticed. However, it turns out that it had been noticed. The article was published on the Chinese social media app on December 19. Three days later, the manufacturer, Hongmao Pharmaceuticals, told police that Dr. Tan had defamed the company.
In early January, as Dr. Tan was boarding an elevator to his apartment, two men flashed badges at him and detained him. It turns out that they were officers sent from Inner Mongolia, where Hongmao Pharmaceuticals is based, to question him. Later, they took Dr. Tan to Liangcheng County. There he was jailed, and remained in prison for over 100 days. The pretext was Article 221 of the Chinese criminal code, a provision that criminalizes to fabricating and and spreading claims that seriously damage a business’s reputation. It’s a provision that is rarely invoked. As a result, Dr. Tan was imprisoned under harsh conditions. Indeed, in one news report, he was described as having to sleep beside a toilet, “crammed with other suspects, with little but steamed buns to eat.”
I managed to find an interview with Dr. Tan after his release. It’s behind a paywall, but the full text can be found on Reddit. In it, Dr. Tan describes why he wrote the article and what happened next:
Caixin: What led you to write your article about Hongmao Medicinal Liquor?
Tan Qindong: One of my WeChat friends suggested I write a popular science article after he read one about (eye-drop manufacturer) Shapuaisi Pharmaceutical. I already had the habit of writing popular science articles. I had long felt that there were problems with Hongmao Medicinal Wine, and that there was false advertising. I couldn’t find any clinical trial data on the State Food and Drug Administration’s official website, and (Hongmao Pharmaceutical) has already been heavily penalized by many local food and drug regulators — precisely because it exaggerated the benefits. Elderly people with heart disease and diabetes should not drink medicinal liquor. China has over 200 million elderly people, over 200 million people with high blood pressure, and over 100 million people with diabetes.
Many old people will buy this medicinal liquor after seeing the advertisements.
And what is the result of drinking it? I wanted to catch their attention, and use strong words to provoke the elderly, to let them read this article and stop buying it. If they wish to buy it, they should first consult a pharmacist and make the purchase based on evidence. The point is, I used intense vocabulary precisely to warn the elderly suffering from chronic diseases.
Do you think your description of the wine as “poison” was excessive?
Dr. Tan: The content of the article is popular science. It has been proved by many medical experts. I have not fabricated anything.
And his arrest:
What happened and who was present when you were arrested?
At around 10 p.m. on Jan. 10, I encountered two police officers by the elevator in my building. They said they were police from the Chebei (an area on the outskirts of Guangzhou) police station, and presented their police ID, and asked me if I was Tan Qindong. I was afraid that they were bad people, so I ran upstairs. I was nervous at the time so I called the police. And then the two officers restrained me. Four people arrived in total to take me to the Chebei police station. That evening they conducted the first interrogation. Afterward they sent me by car to Shenzhen. I stayed in Shenzhen for one night. Early the next morning, I was put on a high-speed train to Beijing, where I arrived at around 5 p.m. or 6 p.m. that next day.
Of course, as I’ve written many times before, TCM is heavily supported and promoted by the Chinese government. Indeed, I’ve described in considerable detail, both here and elsewhere, how TCM was more or less invented by Chairman Mao Zedong, who, because of the shortage of doctors trained in science-based medicine in China after the Communist Party took over, promoted the “integration” of Chinese medicine with “Western medicine” in what has become the model for the integration of quackery with conventional medicine for more than just TCM. Basically, before this process began in the late 1940s, there was no such thing as TCM, t least not as we see it now. There were many strains of Chinese folk medicine, many contradicting each other. The apparatus of the state medical establishment was drafted to take these strains of folk medicine and create a pseudoacademic structure in which TCM was a presented as a unified, consistent whole dating back thousands of years.
The promotion of TCM continues to this day. For instance, in late 2016, China passed a law giving TCM a larger role in its medical system. The law in essence mandates the integration of TCM with “Western medicine,” requiring county-level governments and above to set up TCM centers in publicly-funded general hospitals and encourages private investment in such centers. The law also provides protection to TCM manufacturers, granting special protection to TCM formulas as state secrets, basically proclaiming TCM to be a “national treasure.” It’s not all bad, though. The law also purports to protect endangered species from being used to make TCM products and to require proof of the absence of pesticide and heavy metal contamination. It also will require TCM practitioners to pass tests before they can practice. Those provisions aside, the purpose of the law is primarily to protect the business interests of the TCM industry, promote the integration of TCM into real medicine, evidence be damned, and to pave the way to market TCM to the world more aggressively.
It didn’t last long, as I learned late last year that, beginning this year, China is rolling back many regulations for TCM remedies, despite safety concerns. Draft regulations from the Chinese version of the FDA announced in October declared that traditional medicines can skip such costly and time-consuming clinical trials as long as manufacturers prepare ingredients using essentially the same method as in classic Chinese formulations. Basically, the State Administration of Traditional Chinese Medicine and the Chinese FDA will compose a list of the approved methods. So basically, the formulations will be more likely to be free of pesticides and heavy metals, but there will be no evidence needed that they have any therapeutic effects or that they are safe. One can’t help but note that China’s TCM business is worth $116 billion and represents nearly 29% of China’s pharmaceutical industry.
There is one good thing about Dr. Tan’s ordeal. Publicity about it embarrassed the Chinese government, media attention focused on Hongmao Pharmaceuticals and its history of unfounded and exaggerated health claims for its product that led to several local governments investigating. For instance:
More than two dozen provincial or city health authorities have reprimanded Hongmao Pharmaceuticals over the past decade for misleading advertisements about the therapy’s health benefits. This led to temporary suspension of sales in several cities until the advertisements were removed.
On 16 April, China’s drug regulator issued a statement calling on the company to explain punishments it has received for false advertisements in the past five years, to report all adverse effects recorded in that period and to provide further explanation of the liquor’s safety and efficacy to address public concerns.
The drug regulator also requested that the Inner Mongolian drug agency, which is tasked with enforcing the regulator’s rules, take a closer look at Hongmao Pharmaceuticals to ensure its products are safe. The agency has threatened to revoke the company’s license to make drugs if the company is found to have violated any regulations.
Basically, Hongmao’s complaint against Dr. Tan has backfired spectacularly in a most satisfying fashion. Even the state-run Chinese news outlets have asked how it was possible for the Hongmao Pharmaceutical Company to persuade local officials in Inner Mongolia to arrest Dr. Tan for questioning the health benefits of its flagship elixir and demanded that the company and its state supporters should reveal who authorized his arrest and imprisonment. In the meantime, Dr. Tan has become something of a hero and remains unrepentant. As well he should.
Still, even though publicity has resulted in a backlash against Hongmao Pharmaceuticals and law enforcement officials from Inner Mongolia to the point of the central government turning on both, make no mistake. If there hadn’t been international publicity and outrage over his case, Dr. Tan might still be rotting away in a cell in a Chinese jail. Basically, Hongmao overreached and overreacted, and it’s paying the price. Even now, Dr. Tan is not entirely out of legal jeopardy. The TCM industry and the Chinese government still work hand in hand to protect its profits, stifle criticism, and sell TCM to the world. In China, TCM is not the underdog, and it is not persecuted. The underdogs who are presecuted are critics of TCM. They stand in the way of the full “integration” of the ancient quackery of TCM with real medicine and China’s ability to export that quackery to the rest of the world.
34 replies on “The case of Tan Qindong shows that in China traditional Chinese medicine is big pharma”
I am not terribly surprised that Hongmao managed to get the local police to take action. Major employer exerts pressure/bribes a not well-paid local police chief. We have seen similar things in, was it Texas or Arizona, though in those cases the police did not travel the length of the country to arrest someone.
The real problem seems to be with the State Food and Drug Agency. Still, looking at how Health Canada “approves” complimentary drugs we should not be surprised.
Clearly Hongmao needs to use better ingredients in their concoctions. Here is a company on the leading edge of TCM. https://www.watoday.com.au/world/asia/like-a-horror-movie-my-day-in-a-chinese-cockroach-factory-20180425-p4zbhc.html
I have never understood the aversion to these insects. Some of them are even rather cute https://www.smithsonianmag.com/science-nature/i-am-officially-in-love-with-cockroaches-180960274/
a provision that criminalizes to fabricating and and spreading claims that seriously damage a business’s reputation. It’s a provision that is rarely invoked.
Kleptocrats have a tool for crushing criticism, but they rarely use it? That’s the part I’m skeptical about.
In a slightly milder case, a news editor published an article criticising the TCM scams from Yiling Pharmaceuticals. He was taken to police HQ and held in custody until he deleted it again.
https://twitter.com/TigerBB8/status/970636853295579137
Linky: https://mp.weixin.qq.com/s/ud2OGObNVVIeOwprDBHr_Q?
Mao’s primary justification for deploying TCM throughout China was that the country did not, at the time, have the resources to deploy doctors trained in science-based medicine throughout the country. He chose the cheaper alternative.
The irony is that TCM is often, as in this case, not all that cheap. The bottle shown in the photo that accompanies this post (I don’t read Chinese, so I can’t tell whether it’s a version of the same product Dr. Tan was criticizing) is advertised at a retail price of RMB278, which is between $40 and $50. Even by Western standards, let alone Chinese standards, that’s a lot of money to pay for an OTC product. That phenomenon is not limited to TCM, either; the homeopathic remedy I almost bought (I was about to take it to the cash register when I spotted the words “homeopathic remedy” on the package) was several times more expensive than the product I really wanted.
I also find it disturbing that the regulation of Hongmao Pharmaceuticals seems to be in the hands of provincial authorities rather than the national FDA counterpart. Corruption is an ongoing and serious problem in China. That’s especially true with provincial and local authorities, because, “The Emperor is distant and the mountains are high.”
I heard it as “Heaven is high and the mountains are far away”.
The irony is that TCM is often, as in this case, not all that cheap.
When Mao introduced TCM, the country was very poor. Today, well 2017, “The average monthly salaries for select Chinese cities in the first quarter of 2017 were: Beijing: 9,942 yuan ($1,440) Shanghai: 9,802 yuan ($1,420) Shenzhen: 8,892 yuan ($1,288).
There are a lot of well-off people waiting to be separated from their money. Before we know it, Gloop will be opening in Shanghai.
What’s with the 278 yen on the ad, then?
Oh, right, yuan. Sorry, just woke up.
I followed Orac’s link. You would pay 278 kuai for it in China. It’s apparently available for purchase in the US, on sale for $96.75 (regular price $117), which presumably includes shipping and customs duties that Chinese buyers would not have to pay.
Yah, I used to get paid in both JPY and RMB. Not a morning person.
Click the link. Click the link.
I did click the link beforehand. Sheesh.
The manufacturer’s Web site is kind of fun to poke around on if one doesn’t mind G—le Translate.
Something that didn’t hit me right away when I wrote my reply to Narad: Holy [expletive], you can buy this stuff in the US? Where is the American FDA here? I understand they can’t do anything about Chinese products being sold in China, but I would expect them to have an interest in imported as well as domestically produced alleged medicines.
Not to mention the CITES issue, as one of the ingredients is claimed to be leopard bones.
What a story! He IS a hero.
I’m not surprised by govermental involvement but they actually jailed him.
I used check out products in ethnic enclaves ( “Chinatowns”) and saw many odd medicinals getting exported as well: my friend was able to buy OTC anti-biotics and was recommended interesting looking bottles like the one pictured for arthritis and similar complaints. A few were labelled: I even tried a “female tonic” which was angelica and other herbs, it might still be around.
They sold many pills, teas and drinks mostly labelled only in Chinese.
Still confused about how antivaxers go on (falsely) about vaccine makers being completely exempted from liability for their products, but seemingly have no problem with supplement makers having a huge exemption from having to prove that their products work and are safe.
Motivated reasoning.
Natural == good, Vaccines == bad.
All ‘logic’ is just reverse-engineered from one or both of those conclusions.
Ask an American about traditional Chinese medicine and you are likely to find they have a mental image of an oracular (Note: not Orac-ular) old Chinese man with a long white beard in a silk robe and skullcap, in a shop with lots of little drawers and strange things in jars. Think of the shopkeeper in “Gremlins”. Whenever I encounter someone who thinks really like that, and they’re out there, I can only tell them “He’s been dead for years. Whatever he sold, his grandson now makes in a big factory with smokestacks and a rail siding. He drives around in his Ferrari with expensive call girls snorting cocaine while on the phone with his broker. And the factory isn’t even in China but somewhere where it’s even cheaper to do business, like Gabon or Pakistan.”
Nobody wants to hear it.
re CITES: go to Chinatown in Singapore & you will find sharks’ fins, Saiga antelope horns, & all manner of stuff. I didn’t go looking for pangolin scales but I suspect they’d be there somewhere 🙁
I dug around for Chinese language articles after I saw your post, and oh boy, it was an interesting read or ten (I don’t think I’ve seen so many Chinese matricide/particide jokes in my life). I hope I’m able to supplement this post just a tad.
I haven’t been able to find a copy of the original article in either Chinese or English. The opening snippet I’ve seen discusses the effects of age on the heart, which I assume segues into why drinking the liquor isn’t a good idea for the target audience. If anyone knows where I can find a copy, I’d like to know.
Regardless of the (unknown) concentration of TCM ingredients in the liquor, we know the exact concentration of one drug: alcohol. It is widely reported that the base is 38 proof alcohol. Certainly not something you’d want to drink daily at an advanced age. Speaking of which, Hongmao was advertised as a beverage with health benefits, not a drug, even though it was approved as an OTC drug. In fact, I gather that the fact that Hongmao was technically a drug was not widely known until recently. I’ve come across several examples of product placement where it is served as a sake equivalent.
Of the herbal ingredients, some are known to have potentially serious side effects. For example, Chinese knotweed is hepatotoxic, areca palm is carcinogenic, Chinese liquorice has endocrine effects. Assuming they are present at sufficient concentration for any kind of activity, of course.
Smut Clyde, the fact that Hongmao contains ingredient derived from endangered species was noted in some of the articles I read, with some added number crunching. Acquisition of leopard bones has been banned in China for more than a decade, though pharmaceutical companies were allowed to use up their pre-existing stocks. There is no way their stock lasted until now with a manufacturing volume of 15,000 tonnes/year unless they are practicing homeopathy as well (I don’t think it’s a thing in China yet? At least i hope not).
Onto the regulatory side, I’m not sure Orac is quite correct in assuming this particular company is backed by the Chinese government. Journalist collated an incomplete list of more than 2000 regulatory actions from provincial/municipal governments, including Chongqing and Shanghai, which I consider to be much closer to the central government than Inner Mongolia. Most of the regulatory actions seem to involve advertisement violations, including exaggerated claims of effectiveness, not adequately addressing side effects, and using testimonials from stars/patients/purported experts (banned in China). Apparently all advertisements required prior approval, which they received from the provincial government of Inner Mongolia; even recently, Inner Mongolia government has claimed that there had been no regulatory action against Hongmao since 2014.
I think the most parsimonious explanation here is that this is mostly an issue with the Inner Mongolian government. The other local governments either did not want to escalate the matter to the central government or the central government is being passive for political reasons (greased palms are political reasons, right?). As a company that brings in billions of revenue (and more than enough to bribe with), the local government would naturally favour them (this is China, after all).
Reading some of the stories, I came to the realization that Hongmao sells itself as a panacea that also keeps diseases away, and is targeted at the elderly. Reading between the lines, it plays off the fear of the ravages of age, and of death. The children feel obligated to buy into the scam in hope that maybe, just maybe, their parents’ lives could be extended a bit. And this false hope instead hastens their demise, a theme that everyone who frequents this blog is familiar with.
It is widely reported that the base is 38 proof alcohol. Certainly not something you’d want to drink daily at an advanced age.
Too late to tell me that.
The Queen Mother made it to over a hundred fuelled by her daily gin and tonic. Forget the alcohol, worry about the herbs.
@jrkrideau According to what I’ve seen, alcohol’s the main issue that Dr. Tan was focusing on in his article anyways. It’s dangerous to push Maohong as a health product, to be consumed daily, to a population with (often undiagnosed) pre-existing conditions that can be exacerbated by alcohol, e.g. particular cardiovascular problems.
As for the herbs, I’m skeptical that they were ever in the product in the first place. Some of the claimed ingredients are clearly lies (see: leopard bones), so why should we assume Maohong put anything else in? On the other hand, it would be cheaper for them not to.
Well, there must be something herbal; otherwise, it’s just an unflavored liqueur.
Alternative explanation: They have been misrepresenting the contents of the product. There have been several such scandals in China over the last decade or so, some of them notorious enough to have attracted Western attention (e.g., melamine-contaminated milk). Substitutions for something purported to be leopard bones would be a lot harder to prosecute, because who would know the difference? As long as the product didn’t directly cause somebody’s death, or the death of pets in the West (there was a similar scandal regarding tainted pet food a few years ago), why would they think to look?
It may be true that the provincial authorities in Inner Mongolia, rather than the national government, may be driving this. But they did get local police in Guangzhou to go along with it. It’s like a shady but well-connected businessman in Chicago arranging for the Miami-Dade police to arrest a critic who happens to live in Miami. I don’t know whether the “thin blue line” is a thing in China, as it is in the US.
But they did get local police in Guangzhou to go along with it.
Nature says, “In January, Liangcheng police travelled to Guangzhou to arrest Tan and escort him back to Liangcheng, according to a police statement”.
How much if any involvement the local police in Guangzhou had is not clear. It could have been anything from a snatch and run by the Inner Mongolian police to active help. Plus, how are the Guangzhou police to know the warrant is dubious?
Let me address your second paragraph first: Police from Liangcheng County, Inner Mongolia went halfway across China to Guangzhou, arrested Dr. Tan, and took him back to Liangcheng County. At no time was any part of Guangzhou involved, which is why I believe Maohong was backed at the provincial government level, not national. This is apparently unusual enough (if still legal) even in China that it provoked an outcry.
Eric, people added melamine to milk because someone was checking for protein content. Exactly because nobody can tell whether leopard bones had been steeped in the alcohol and subsequently strained out, there’s no reason for them to add anything at all in the first place. Besides, parsimony suggests livestock bones would be a cheap and readily available (and equivalent) substitute for leopard bones, if any, not more esoteric substances.
I’m more worried that they are adding undeclared pharmaceuticals, the way some weight loss “supplements” do.
I hope the leopard bones are a fake—and all the other animal parts too.
I’m sure if someone from the quack side reported on this, like Health Deranger, it’d be a righteous action of Chinese govenrment against dangerous psychopath who’s trying to endanger the masses by spreading disniformation about important health issues and discourage people from using potentially life-saving therapies. Wait a second, that descriptions sounds vaguely familiar….
Actually Mikey is no fanboi of China ( i.e. PRC) or its government : he’d have to spin it in other ways- let’s see, SB doctor/ evil China. Perhaps he’d stay away from the story entirely because it shows how TCM could be dangerous. Like prn’s head loon, he celebrates natural medicine, traditional remedies and herbs whilst despising SBM.
I wonder what he’d say about leopard bones though. He’s loves animals supposedly.
At any rate, he labels some of his products ” China free” ( right, no shards of porcelain amongst the kale chips).
He is married to a woman from Taiwan and lived there for a while trying to make his fortune: he recounts the story in an article called “My brush with poverty” or suchlike. He thinks that Taiwan is fabulous and has businesses registered there.
“He thinks that Taiwan is fabulous”.
My daughter recently returned from about two and a half years in Taiwan, where she taught English and studied Mandarin. From everything she has to say and show, and there is no reason to doubt her, it IS fabulous.
As noted upthread, it’s the provincial authorities who seem to be backing Hongmao, while the relevant national authorities are at worst indifferent and mostly skeptical. That would be Adams’ angle: maverick provincial authorities standing up to the national government of China and that pesky SBM doctor at the same time. In the unlikely event that Adams is actually aware of how far apart Guangdong and Inner Mongolia are (as I noted above, the distance is similar to that between Miami and Chicago), he could use that to support the “maverick provincial authorities” angle.
@ Eric:
Ha ha!
Mikey could do that!
AS you may know, he now lives in Texas and has adopted the attitude ” Don’t mess with Texas” or him or woo in general so that can be easily applied to maverick-y down home local authorities defying Big Government Corporate Fascists.
Fellow libertarian freedom fighters perhaps, busting the SBM doc. Bet those locals were armed, too.