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Health See other Health Articles Title: EU herbals ban brings two Chinas closer together Traditional Chinese medicine (TCM) has for a long time been fighting for status in a world dominated by Western medicine, and now advocates from the Chinese mainland and Taiwan are joining forces to pursue global recognition for TCM. Both the mainland and Taiwan attach great importance to TCM, calling it "an indispensable part of Chinese culture," State Administration of TCM Deputy Director Yu Wenming told a seminar on June 11 at the third Straits Forum in the southeastern city of Xiamen. Taiwan has more experience and advantage in "hospital management, health care, drug research and development and international marketing," whereas the mainland boasts great development resources and a huge market, Yu said, adding that the government has made TCM vital in its medical reform plan. "The two sides have broad room for collaboration," he said. Cross-Strait cooperation on TCM started in the late 1980s, but in the past, both sides focused more on short-term benefits, but now they have a shared goal -- to jointly promote TCM globally, which would benefit both in the long run, Yu said. DIFFICULT ROAD ABROAD A European Union directive on traditional herbal medicinal products, fully implemented in May, shocked China's ambitious TCM sector that has been wanting to enter the global market. The directive requires that all herbal medicinal products obtain a medical license from any EU member state before it can be allowed in the EU market. However, not a single Chinese herbal medicinal product has been granted a license so far, mainly due to the prohibitive registration cost and lack of required evidence to prove the product has a 30-year history of safe use, including 15 years in the EU. Actually, by elevating the threshold, the directive is trying to force China's TCM producers to abandon the EU market. "On one hand, the EU doesn't believe that science can prove the efficacy of TCM, which is used by the EU as a reason for its policy," said Shau Yio-Wha, general director of the Biomedical Technology and Device Research Laboratories of Taiwan's Industrial Technology Research Institute. "On the other hand, the EU member states covet the profits of the herbal medicine market and have invested heavily in it themselves," he said. "Germany began herbal medicine research many years ago; therefore, the directive also aims to protect its own industry." In spite of this, TCM's globalization ambition has not been doomed by the directive. On June 1, the Foci Pharmaceutical Company, based in Lanzhou of China's northwestern Gansu Province, applied for a product license for a medication containing concentrated Chinese angelica, a type of herb, from the Swedish drug administration, becoming the first TCM producer to apply for a license in an EU country. If the company's medication is authorized in Sweden, it will be accepted by other EU countries. As the world's largest market for herbal medicinal products, the EU takes up more than 40 percent of the market share. With a history of more than 2,000 years, TCM did not enter the EU market until mid-1990s, where it has been sold to customers as food supplements instead of drugs. While TCM's export value to the EU only made up 14 percent of the total in 2010, industry insiders still have had serious concerns about its future. "Actually, it's unnecessary to worry about TCM's development following the EU ban, as the mainland's huge market is there, complemented with strong official support," Shau said. But he added that the world heritage should be "widely promoted and shared by all mankind in order to pass it to future generations." Last November, acupuncture, a TCM therapy, was listed by the UNESCO as an intangible cultural heritage. The key for TCM's globalization is to make it understood by Westerners, Shau said, adding that efforts should be made to "modernize it and use science to prove it" by answering the question, what kind of mechanism on Earth uses TCM for treatment? "But never use the concept of Western medicine to explain TCM," he warned. The concept of TCM is a reflection of China's dialectic philosophy. In TCM, the understanding of the human body is based on the holistic understanding of the universe as described in Taoism, and the treatment of illness is based primarily on the diagnosis and differentiation of syndromes. Traditional Chinese culture, with thousands of years of history, enabled TCM to pass from one generation to another. TCM includes various forms of herbal medicine, acupuncture, massage and dietary therapies, which are a common part of medical care throughout East Asia but are considered alternative medicine in the West. Western medicine, developed in only hundreds of years and encompassing methods such as surgery and radiation, cannot cure all diseases and is weak at infectious disease prevention, which is exactly TCM's strength, according to Shau, who said that TCM "has every reason to develop and thrive." Honeysuckle, a major TCM ingredient, sold out during an outbreak of the A/H1N1 influenza in 2009, which caused nearly 180 deaths in China, as the herb was said to prevent the infectious disease. Its price surged ten fold due to the intense demand. Despite TCM's magical effect, it's not a testable method, which complicates research on TCM's efficacy. TCM uses different physiological and disease models from that of modern medicine, and makes a number of assumptions that are inconsistent with scientific principles. "It's very difficult to explain TCM to Western medicine practitioners, as the two have fundamentally different language systems and for them, TCM is a foreign language," said Prof. Wang Yanhui of Xiamen University's Medical College. To make TCM a universal language, Shau said the mainland and Taiwan should join to improve TCM's "clinical evidence," introduce new methods such as "using genes to prove its curative effect," and draw up a standard in order to break its international hurdles. "Currently, there are no standards for TCM, so the mainland and Taiwan should work together to formulate one accepted by the global market," Shau said. However, Prof. Wang said a standard is "hard to establish," as it is difficult to "quantify" TCM therapies. For example, different physicians would prescribe different medicine to different patients even if they share the same illness, but practitioners of both sides look forward to a standard. SEEK STATUS In Taiwan, efforts of seeking status for TCM have never ceased, as the herbal medicine's development there is far less rosy than that on the mainland, Shau said, adding that TCM accounts for less than one twentieth of the entire medical sector on the island, whereas it takes up about one quarter on the mainland. TCM in Taiwan is considered an alternative medicine, and TCM hospitals are banned, whereas such hospitals are thriving on the mainland, and its development has been put into the 12th Five-Year Plan (2011-2015). "In order to promote TCM in Taiwan, many practitioners turned to outside markets, especially the West, decades ago, to persuade Westerners to understand or accept TCM," Shau said. Taiwan should share with its mainland counterpart its experience of overseas promotion and the medicine's modernization, he said. Traditional TCM holds that doctors prescribe medicinal ingredients for patients who will decoct them in pots at home or ask pharmacists to do so, but it's not convenient for the users to always take decoction with them. "Busy people prefer a 'pill' instead of decoction, and instead of pure treatment, some use TCM for health care and disease prevention," Shau said, adding that Taiwan is working hard to modernize TCM manufacturing and service. However, both TCM sectors of the mainland and Taiwan still cannot reach a consensus on some modernization methods. Mainland practitioners usually stick to the traditional way of decoction, but some Taiwan doctors believe that the efficacy would be greatly differentiated after the prescribed ingredients are watered. Instead, Taiwan manufacturers use modern technology to extract ingredients into powders so that when taking medicine, users can take the powders while drinking some water. "TCM physicians across the Taiwan Strait should conduct exchanges more often to discuss the differences and improve the medicine," Shau said. Wang Chengde, director of the department in charge of exchanges with Hong Kong, Macao and Taiwan under the State Administration of TCM, said that Taiwan boasts "abundant experience and channels for TCM's international marketing." "Before the mainland's reform and opening up in the late 1970s, Taiwan TCM practitioners set up clinics overseas, helping the medicine's overseas promotion," Wang said. Moreover, granular formulation's production on the island is more mature than that of the mainland, and Taiwan's TCM granules have been exported to many countries, he said, adding that the island's TCM could "seek development with the help of the mainland's huge market." According to a cross-Strait medical cooperation agreement signed last December in Taipei, the mainland and Taiwan will conduct more cooperation on measures ensuring safety of herbal medicinal materials and TCM clinical research and academic study, which Shau said establishes "a solid platform for TCM's joint promotion." Based on the agreement, Wang said the two sides could jointly develop new drugs and share qualification and clinical data, which would help accelerate the process for new drugs to hit the market. However, as for TCM preparations, produced by both sides respectively, they could not enter the other's market due to different drug standards, he said. The two sides started TCM cooperation as early as the late 1980s when some Taiwan medical students came to study in mainland schools such as Xiamen University's Medical College in Fujian Province, facing Taiwan across the Strait, where people used the same Minnan dialect with that used in Taiwan, Wang said, adding that TCM cooperation across the Strait had never been affected by political changes. Mainland-Taiwan relations entered a tense era after the Kuomintang lost a civil war with the Communist Party of China and fled to Taiwan in the late 1940s. In the 1980s, Taiwanese were allowed to visit the mainland, and TCM became the earliest field of cross-Strait exchanges. Currently, TCM cooperation across the Strait covers education, academic research and trade. More than 90 percent of Taiwan's TCM raw materials are imported from the mainland, Wang said. He said the two sides would jointly develop new drugs for the international market to combat cancer and other major infectious and autoimmune diseases.
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