The case of Tan Qindong shows that in China traditional Chinese medicine is big pharma

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.