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Hard Pill to Swallow?

Hard Pill to Swallow?

The announcement of this year's Nobel Prize in medicine has triggered a new debate on traditional Chinese medicine, and reminds us that modern medical science depends on inspiration from every possible source.

A Chinese scientist winning the Nobel Prize for an anti-malarial drug based on an ancient remedy has rekindled the debate about traditional Chinese medicine.

Amid reports on crowded tourist destinations and shopaholic crazes typical of the "golden week" holiday, the news that a Chinese pharmacologist just won this year's Nobel Prize for Physiology or Medicine sent notes of congratulations flying through cyberspace like a blizzard in deep winter. Tu Youyou is the first Chinese national to win a medicine Nobel, and the first Chinese woman to win any Nobel. Pride was running high.

But beneath the flutter of excitement was a serious debate, which has been going on and off for quite a while and is naturally reheated once the Nobel news broke out. It concerns the validity of traditional Chinese medicine, or TCM for short. You see, Tu was recognized for Artemisinin, a therapy against malaria that is extracted from a herb popularly known as sweet wormwood. It was first mentioned in an ancient Chinese prescription more than 2,000 years ago.

In the renewed clashing of opinions, some view Tu's Nobel as the ultimate endorsement of TCM while others contend that it proves the opposite-that Western medicine is more effective-because even in China's regulation of the pharmaceutical industry Artemisinin is classified as a "chemical drug", which is colloquially equivalent to "Western medicine".

Now I'm no expert on TCM or science of medicine in general. But reading through the posts has enriched me with knowledge to offer a layman's take on the matter. I truly admire those like Fang Zhouzi who possess a vast warehouse of information and knowledge and can help explain the arcana of science to us outsiders, but on the other hand I feel that many tend to go to extremes when they draw conclusions on the virtue, or the lack thereof, of TCM.

As I see it, the name "Western medicine" (xiyao) as a catch-all phrase is a misnomer that serves only to polarize. The methodologies for making these drugs may have been first invented in Western countries, but they are now adopted worldwide. What if we add "Western" to other sciences such as physics, biology, architecture etc? Say, if we call a building with reinforced concrete instead of wooden nails "a Western house", people will raise their eyebrows as if you are from another planet. The adjectives "Western" and "Chinese" are used only to describe a building's style or decoration.

I see the term "Western medicine" as a vestige from the early days when China only started to import scientific knowledge and products from more advanced countries. But we no longer call an electric bulb "a foreign lamp" (yangdeng). But when you say "I prefer Western medicine", there is the instant connotation that you stand up for science (in the eyes of TCM detractors) or you have spurned your native culture (in the eyes of TCM defenders).

Now, nobody will accuse you of cultural betrayal if you say you like an electric lamp over an oil-fueled one.

Attitudes towards TCM, however, run the full spectrum from heartfelt embrace to total rejection. On one end are those who extol it as the magic potion that has eluded Western medicine. And on the other end are those who are convinced it is pure superstition. I don't agree with either side.

There is obviously a cultural aspect to TCM. It is intertwined with traditional Chinese philosophy and metaphysics. Like religion, very often you have to believe it before you can experience its efficacy. But medicine is a science and as such it has to have things that are absolute-unlike culture, which is relative. While a color or an architectural style can incite different feelings in different people, a drug usually works the same within a certain range of variations such as patient resistance, weight and age.

Culture thrives on fuzziness. Words with multiple meanings are often employed for special effects. A story is considered good if it leaves room for speculation, say, in the movie The Life of Pi. But from the perspective of science, such ambiguity can be deadly. It calls for methods and products that are measurable in every aspect.

I have the weird notion that ancient Chinese wanted their remedies to be accurate, but given the circumstances they had to opt for a fuzzier approach. Anyone who has been to a TCM drugstore will understand this dilemma: A sales assistant uses a small Chinese scale to weigh each ingredient, but sometimes he would simply grab a pile and spread it evenly over each packet. The way to determine the quantity is reminiscent of a chef. The goal is to be exact, but approximation is tolerated when quantifying becomes too troublesome.

Which implies that, had ancient Chinese possessed the tools, they would have resorted to trial-and-error not that different from modern science. We must remember that in antiquity there were a lot of things not yet available. People back then had to make do with what they had got. But for people who live with the benefit of modern science, there is no reason why we should not use it. And that was exactly what Tu and her peers did. They took a seed from ancient China and ran it through the vetting process of modern medicine.

Of course, thousands of other TCM seeds did not come out of the grinding mill with any fruit. But that is the nature of testing, and that is also where its value lies. Big pharmaceutical companies engage in prolonged and expensive tests before coming up with a drug that can be approved for the public.

TCM often relies on a hunch and is tested more sporadically. But sometimes an epiphany on a smart mind can open up a new vista, such as Tu coming up with low-temperature extraction for Artemisinin. For that, she has acknowledged the TCM influence and considered her win "an honor for China's science cause and traditional Chinese medicine in their course of reaching out to the world".

To develop modern medical science, we need inspiration from every possible source. And there is no reason we should categorically deny TCM as one of these sources. However, while we can embrace it as part of our heritage, we must subject individual therapy to the rigorous reviews demanded by today's consumers.

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