Column | China's Most Money Line: Why Chinese People Can't Take Good Medicine (3): "Can you be smarter than your ancestors?"

This is "China's Most Money Line", I'm Zichao. This issue is the last issue of the series "Why Chinese People Can't Take Good Medicine". In this issue, we will talk about a medicine that is not only easy for Chinese people to eat, but also said to be very good - traditional Chinese medicine.

"Can you be smarter than your ancestors?"

The Covid-19 pandemic has dominated Chinese life for the third year, and it still shows no sign of stopping, even though most of the rest of the world has seen it as a common flu-like seasonal contagion. Whenever there is a new wave of epidemics, China's official media will launch a variety of "prevention of the new crown Chinese medicine package", the content of which is similar in different places, except for Forsythia, Houttuynia cordata, and honeysuckle, which are used to deal with daily cold. Common Chinese Herbal Medicine". Many people who were quarantined at home were watched by community epidemic prevention personnel and drank the bowls of bitter medicine soup on time and in quantity. Of course, most of the time, you don't need to be so troublesome, you only need to take the absolute first Internet celebrity medicine "Lianhua Qingwen Capsule" in recent years. This magical medicine, brought personally by Academician Zhong Nanshan, the "Guo Shi Wushuang", not only created an unprecedented sales miracle in China, but was also used by Chinese embassies and consulates in various countries to distribute "anti-epidemic love packages" to overseas Chinese. Mass delivery in Hong Kong. There are even many people in many countries who have started daigou business. Although this drug is not licensed in many countries, the Singapore government even issued a special document stressing that this drug cannot be used as a new crown treatment, but it is still warmly sought after by Chinese around the world.

According to Chinese media, the "anti-coronavirus efficacy" of Lianhua Qingwen Capsules is not ordinary. What delta variants and Omicron variants are not to mention, it can prevent infection and severe illness, and can cure the new crown, and there are no side effects. Compared with all kinds of vaccines that are swayed by frequently mutated viruses, or therapeutic drugs that have many restrictions on the population and symptoms, and are still in the experimental stage, this "easy-to-get" god. Medicine can really satisfy the Chinese people's longing for the magic medicine that "cures all diseases". Although the content of this medicine is nothing more than some herbs that can " clear heat and detoxify " according to the theory of traditional Chinese medicine, its official instructions only say that it can "relieve symptoms such as headache, fever, nasal congestion and other symptoms caused by new coronary pneumonia". Although two years after the outbreak of the new crown, research institutions all over China have released a lot of experimental results about "Lianhua Qingwen Capsule is effective against the new crown virus", but it has always been only some inconclusive "in vitro experiments", which are far from ordinary modern medical drugs. The required pharmacokinetic analysis, phase III clinical trials, double-blind verification, etc., are too far behind. However, this does not prevent the Chinese people from being led by the party media, and I believe that in addition to the "prison-style epidemic prevention" with Chinese characteristics, China has also successfully fought against the new crown epidemic by relying on the magic of traditional Chinese medicine - after all, since 2021, in the official caliber No one has ever died from Covid-19 in China - but it makes one wonder why the Chinese government and the Chinese are scared to death by it.

Chinese people's trust in traditional Chinese medicine can be said to be a kind of culture, of course, I prefer to call it belief. I'm not a popular science channel here, and I don't plan to talk about evidence-based medicine, placebo effect, double-blind experiments, etc. I only point out one point here: the so-called "Chinese traditional medicine" is not accurate, and its English name reveals its trump card - "traditional Chinese medicine". The so-called "Western medicine" is actually the current popular modern medicine, which is based on a series of disciplines such as anatomy, genetics, and biochemistry. Western medicine" is fundamentally different. This kind of prefix that emphasizes national attributes is itself a century ago, out of national chauvinism, the Chinese people beautified their own backwardness as cultural differences, and created the so-called "antagonism between Chinese and Western medicine". A hundred years ago, modern medical diagnosis and treatment methods were still quite limited. From the perspective of ordinary patients, they may still be regarded as "two peaks side by side", but after a century of rapid technological development, more and more advocating for "tradition" turned into a form of psychotherapy.

Despite the rapid development of modern medicine, like all sciences, there must be things that are not yet understood or temporarily impossible to achieve, let alone dealing with new diseases such as new coronary pneumonia. Moreover, scientific laws are statistical results drawn from a large number of samples, and cannot perfectly explain various individual cases. This is the reason why all kinds of traditional medicine and alternative medicine still have a place in modern times, similar to why modern people still need religious belief. Even in Western countries, various alternative treatments from different cultural backgrounds such as herbal medicine, aromatherapy, and foot massage are huge industries.

But unlike other places, in China, this kind of "traditional medicine" is not only incorporated into the public medical system, but also has an equal status in the official discourse with the so-called "western medicine" or modern medicine. In particular, this pursuit is no longer the spontaneous behavior of the people, but has been incorporated into the official system. Since Xi Jinping came to power, based on the principle of so-called "cultural self-confidence", not only has traditional Chinese medicine been included in the basic education of primary and secondary school students, but also medical institutions at all levels are required to implement "integration of traditional Chinese and Western medicine" in diagnosis and treatment. With the advancement of modern medical technology, more and more diseases can be cured, and the traditional medicine that has been "combined" has become more and more "effective". This coincides with the propaganda of official public opinion. It took scientists from all over the world two years to come up with a special medicine for the new crown, but we discovered the "magic medicine" in the first month. This can't be said to be a victory for Chinese culture, isn't the Chinese awesome? Yes, according to the concept of many Chinese people, "You can still have the wisdom of your ancestors"? It's just that most people don't realize that the average life expectancy of "old ancestors" is less than 40 years old, and most people simply cannot live to the age of cancer and "three highs".

"Unknown" efficacy

In China, when you go to the hospital to see a doctor, it is easy to be prescribed a bunch of proprietary Chinese medicines by the doctor. These drugs are beautifully packaged and bulky, and compared with modern drugs whose names are hard to remember and are banned from being used in their trade names, the names of these drugs are very straightforward and kind, and they can say themselves freely” "Antivirus", "Nourishing the Stomach", "Treatment of bruises and injuries". The dense instructions for "western medicine" are not only difficult to understand with various chemical terms and molecular diagrams, but also very scary: almost every drug can, albeit minimally, cause all kinds of serious side effects that can lead to death. However, in terms of pharmacokinetics, side effects, and contraindications, these friendly ancient cultural treasures have only four concise Chinese characters: "unclear".

As we mentioned in the first episode of the program, it takes an extremely long time to develop a new drug, requires a high investment and faces a high risk of failure. From proposing a potentially effective molecular structure, to in vitro cell experiments, animal experiments, and clinical experiments, this long and risky process can only be done by a few large international companies by relying on the strong spending power of developed countries. In China, a Chinese patent medicine only needs to copy a prescription from an ancient wire-bound book, indicating that the prescription is a general "prescription", and then there is no basic food safety problem, that is, it will not directly eat dead people. Does it sound incredible to be prescribed to patients along with those modern medicines piled up by gold and time?

Of course, many people will cite various examples to prove the effect of these drugs, and I have no intention of denying them. After all, traditional medicine has also developed in practice for thousands of years, and many drugs and treatment plans have been proved to be reasonable. In fact, many commonly used drugs such as aspirin and quinine are also derived from traditional medicine. However, the theoretical framework and analytical methods of traditional medicine have long been left behind by the rapidly developing modern technology. It cannot analyze the experiences passed down from generation to generation. The most prominent problem is that it cannot distinguish between correlation and causality. Some superficial features to summarize the law, and then use complex circular arguments to justify it. A well-known example is "getting angry" that everyone in China is familiar with. Its symptoms, causes, and treatment methods span as large as n medical categories. As well as the "cool and hot nature of food" that almost no one can explain clearly, it is also a chimera system that is constantly patched and patched. In fact, developed countries such as the United States and Japan do not deny the traditional medicine, but use modern technology to find its active ingredients, determine the mechanism of action and toxic and side effects, and then formally incorporate it into the medical system. Such stories have also happened in China, and the well-known artemisinin is the most prominent result of this path.  

Whether the "wisdom of the ancestors" is useful and how it works is a scientific question. But the effect after using it is really a matter of personal experience. In this regard, the wisdom of the Chinese people has a very short and simple solution - secretly adding western medicine ingredients, which also makes many people think that these medicines "really work", and it has almost become a default operation. In addition to those traditional medicines that are packaged as "pure natural", many people do not consider their side effects at all when taking them, and it is "unclear" anyway. These have caused serious security risks. For example, a “Longgan Xiedan Pill” from the time-honored Tong Ren Tang contains aristolochic acid, which can cause uremia—a considerable number of Chinese herbal medicines contain such ingredients. Another example is the cinnabar Anshen Pill, which is said to treat "children's convulsions". Its true mechanism of action is actually mercury poisoning. It is not their fault that the ancestors could not understand the ingredients of these drugs and their mechanism. We 21 The modern people of the 20th century continue to waste countless money and human lives on this, and continue to be "unclear", it is really unreasonable.

Very clear money view

Traditional Chinese medicine is shrouded in various "unclear", but the economic benefits it brings are very clear. Hospitals and traditional Chinese medicine clinics have an output value of one trillion yuan, providing employment opportunities to millions of people. But what we are talking about here is mainly the special interests generated by "traditional Chinese medicine" in an environment with Chinese characteristics.

The first is that proprietary Chinese medicines provide a large portion of the hospital's revenue. Seeing a doctor in a Chinese public hospital is hard to avoid being prescribed a lot of proprietary Chinese medicine. As mentioned above, these drugs are all "unclear", but the prices are unequivocal, and they are often not fully reimbursed by medical insurance. These are probably useless, expensive and potentially harmful things, but they are an important source of income for hospitals and doctors. Because as we mentioned in our last episode, public hospitals in China are all "medicine to support doctors". But now with the promotion of centralized drug procurement, the prices of core drugs in the medical insurance catalog have been suppressed again and again, and there is not much profit margin allocated to hospitals and doctors. Although the total price of these "not yet clear" drugs is several orders of magnitude lower than that of imported patented drugs, they can be stuffed into any prescription for common minor illnesses. Coupled with high profit margins, the small amount can add up to a big income.

As we said before, traditional Chinese medicine can enter the medical system without the long cycle and high cost of modern drug development. The cost of traditional Chinese medicine companies is only to grind some herbs into powder or extract and concentrate them, and then package them into various medicines. This means that the industry itself has huge profit margins. According to statistics, the gross profit of sales in the traditional Chinese medicine industry is as high as 60%, which can be described as huge profits. Of course, because of the high homogeneity and low barriers to entry in this industry—everyone copied the recipes from those ancient books, and everyone had to spend a lot of money on marketing and channel expansion, resulting in an average net profit margin of only 15%——From this perspective, Chinese traditional medicine is not the biochemical pharmaceutical industry, and its model is closer to the fast-moving consumer goods industry. The pattern of this industry is obviously very close to the fast-moving consumer goods industry: a few giants rely on their own size advantages, their brands are well-known, and they have abundant market channels, which can capture most of the market share and earn profits far higher than the industry average. There are basically no original drug companies in China. The large-scale APIs and generic drugs are just as hard-earned as toys, clothing and small household appliances. However, there are many giant star companies in the "Chinese medicine" sector. The advertising is well-known, and the annual sales are often tens of billions. They are also the darling of the capital market - just look at the stock prices of Ma Yinglong and Pien Tze Huang.

Last but not least, a considerable number of large-scale "TCM" enterprises belong to local state-owned enterprises. Due to its high profits and good cash flow, it has always been a major taxpayer of local finance and has established a very close relationship with the local government. The most famous incident in which the local government escorted local "Chinese medicine" enterprises was the incident in 2017 when the Inner Mongolian government hunted down doctors who posted online criticism of "Hongmao medicinal wine" across provinces.

"Is it enough for Chinese people to take traditional Chinese medicine?"

I have also emphasized earlier that this program is not a popular science program, and has no intention to interfere in the "controversy between Chinese and Western medicine", nor does it intend to derogate the belief in traditional Chinese medicine among the Chinese. But the real problem in China is that "Chinese medicine", as a recognized "alternative therapy", has been crowded into the public medical system organized on the basis of modern medicine on a large scale. Possibly diverting funds that could have bought more drugs with scientifically proven effects.

What's more serious is that after Xi Jinping came to power, the Chinese authorities' respect and promotion of traditional Chinese medicine has far exceeded the level of "cultural promotion and inheritance", and it has been fully embedded in the public medical system. ". It is unavoidable that the purpose of strengthening the status of "traditional Chinese medicine" is to achieve import substitution in the field of medicine? Two years after the outbreak of the new crown, this fear has become a reality. The Chinese authorities have always refused to import more effective vaccines, and are unwilling to buy large quantities of proven effective new crown medicines. Instead, they called on the people to drink traditional Chinese medicine every day to prevent the new crown with a 1984-style absurdity. Under the operation of this new era, it will become more and more difficult for Chinese people to take good medicine.