The high cost of traditional medicine: pandemics and illegal trade

Pangolin scales used in traditional Chinese medicine, Credit: IUCN

In February 2020, the Chinese government temporarily suspended trade in wildlife products, animal body parts, organs and live animals used for nutrition, fur production or Traditional Chinese Medicine (TCM). This decision was met with praise, however, the decision will more than likely be revoked once the current pandemic is brought under control.

Chinese traditional medicine uses a number of practices, such as acupressure and acupuncture, but also a wide range of plants, fungi, and animal parts for which no mechanism of action is often established. In this form of alternative medical practices, which is a common name for all those medical practices that are not based on postulates of Western medicine, some 1000 species of plants and 36 species of animals are used, many of which are rare and endangered. It is fair to point out that there are also ingredients in Chinese traditional medicine that have been proven to be useful, such as the Artemisia annua plant, known in our country as the beyatran, which contains anti-malarial properties. To explore the potential of this plant, known as quinghao in China, Chinese chemist Tu Youyou received the Nobel Prize in Physiology or Medicine in 2015.

Impact on biodiversity

In a paper published in Biodiversity Conservation in 2008, the authors, Li Zhang, Ning Hua, and Shan Sun, explain the concept of Chinese traditional medicine: “The Chinese trade in wild species that can be eaten or used in medicine is thousands of years old. "The skin can be worn, the feathers can be used, the meat is edible, and the organs can be used for medicine." Throughout Chinese history, wild animals have been viewed as an important source of food and income. From a traditional Chinese perspective, wildlife is a resource that can be exploited, not something that needs to be protected for its intrinsic value. "

The authors of this paper emphasize that the concept of animal protection has not yet been accepted in China and this way of thinking and acting that nature should be protected came from outside China. Noting that China's strong economic growth has led to many more Chinese being able to afford to buy wild-animal preparations, that it is actually a lifestyle for the new rich, and that opening China, especially to Laos and Vietnam, has provided a new source of wildlife , the authors warn of the unsustainability and dangers of such wildlife exploitation.

This paper examined people's attitudes toward wildlife use in China, and it is interesting to note that 78.8% of respondents in a sample of about 1300 said they had never consumed any of the wildlife listed in the questionnaire. The trend in China and the Far East seems to be that younger people generally do not use traditional medicine, and that older people and the class of newly rich are more likely to use these preparations or consume the meat and organs of these animals.

The demand for Chinese medicine and wildlife trade in general has significant repercussions. In addition to creating conditions that facilitate the passage of species-specific viruses to other species, this also leads to an increase in illegal animal trade and poaching. Annually, the Chinese economy earns between $50 billion and $60 billion from the global market for traditional medicine.

One of the things on the list of high priced products used in Chinese traditional medicine is eijao, donkey gelatin. A pack, or portion, of this gelatin, obtained by cooking donkey skin, costs well over $100, and the price of this product has tended to rise: from $32 in 2000 for a box containing 250g to as much as $435 in 2017, with an even higher price in 2018 . This substance is used in traditional medicine for a wide variety of ailments and symptoms, from bleeding, dizziness to dry cough and insomnia. It has even been recommended as a means of creating new blood cells in patients who have myelosuppression due to radiation therapy. There is no good reason or proof that this substance is effective.

However, as demand for eijao gelatine, Chinese authorities reduced taxes on these goods and the number native donkey populations decreased in China. During a 20 year span, from 1996 to 2016, the population of these animals halved. As a result, the market for hungry extravagant "drugs" has been turned to the African donkey populations. Eventually, the African states of Tanzania, Niger and Botswana must ban these products in order to protect their donkey populations. Unfortunately, these bans usually mean an  increase in poaching and illegal exports.

Chinese traditional medicine abounds in recipes that use parts of the tiger (bones and genitals), deer and rhino horns, and pangolin shells. Some of the animals used in these "recipes" are cavalry (Hai Ma in Chinese medicine), shark fins, a series of reptiles and amphibians, and a number of invertebrates, including scorpions, poisonous centipedes, leeches and Spanish flies, containing the poisonous cantaridin.

In 2006 and 2007, China tightened its legal measures regarding wildlife trade - tigers and other Asian cats, but this had unexpected consequences: traders began to "fill the gap" between supply and demand with lions. According to a 2015 study published by the Wildlife Conservation Research Unit (WildCRU), an international organization called TRAFFIC and the University of Oxford, there has been an increase in the number of lion skeletons on the market. Lion bones are considered to be a viable substitute for tiger bones and are easier to procure because lions are not on the endangered species list like the tiger. There is also the matter of trophy hunts.

Due to the use of their shells in Chinese medicine, Pangolins - scales have become an endangered species and some call them the most hunted animals. As many as 20% of illegal animal trafficking is from different types of pangolin and according to the International Union for Conservation of Nature (IUCN ), about one million of these animals were fished in the decade before 2014.

Although pangolins - all 8 species - are on the IUCN Red List, people are willing to pay a high price for their meat, and it's no secret that pangolin meat is served as luxury food at banquets across the Far East. As for pangolin-based medical preparations, they are used to prevent blood clotting and for a number of gynecological problems, such as blocked fallopian tubes in the treatment of infertility. Shells are also used in some African countries as a traditional remedy, and it should be remembered that the use of such pseudolecks is not restricted to China or the Far East. There is no rational justification or scientific evidence that pangolin husks are effective in these cases, nor justification for eating their meat.

Impact on virus spread

Although it has been suggested that pangolin is an intermediate species through which the new SARS-CoV-2 corona virus has leapfrogged from bats to a new human species, there are different opinions. Dr. Christian Drosten of the Institute of Virology at Berlin's Charité University Hospital and a major expert on SARS and SARS-like diseases, in an interview with the Guardian, pointed out that the 2003 SARS virus was found not only in civettes but also in kunopas.

Civettes, which are not cats, but are often mistakenly called cats, were the "inter-species" from which the SARS virus (more specifically SARS-CoV-1) leapt to humans. Raccoon dog, Nyctereutes procyonoides, is a small beast from a family of dogs living in China, Indo-China, Japan and even one part of Siberia, and looks very much like a raccoon. Unfortunately, it is often grown for the needs of the fur industry. The farms on which this creature is raised are also potential candidates for where the 2019 pandemic began.

Wild animals are also used around the world to make handicrafts and souvenirs, for decoration (the skins of killed animals) or as exotic pets. Another source of danger is precisely the illegal trade in wildlife, both in the abundance of specimens of these species in the wild and in human health, as illegal trade does not imply quarantine measures. This is a convenient way of spreading various diseases, and is especially dangerous in terms of rabies.

In May 2019, the World Health Organization decided to include the practice of Chinese traditional medicine in the 11th revision of the International Classification of Diseases 11, ICD-11. The Chinese government has characterized this as one of the steps towards the internationalization of health care and as a great help in opening up medical centers practicing this medicine worldwide.

However, this step is at the same time a step towards legitimizing obscure practices and preparations that have not undergone sufficient controls or have adequately determined their mode of action, safety, side effects and overall effectiveness. Equating these folk remedies, "woo-woo" and mumbo-jumbo practices with proven effective drugs under the roof of ICD-11 also gives the green light for different uses of wildlife exploitation. The World Health Organization was then accused on several sides of giving in to the pressure from the Chinese government and that the decision to include Chinese traditional medicine in such an important and influential document would do much harm.

Attempting to give birth to the history of medicine could have been done in a different way, not by lifting it to pedestal practices that did not pass the rigorous controls that other medical devices undergo. An editorial Scientific American commented on this decision as something that could diminish the credibility of the World Health Organization. Chinese traditional medicine is found in module 1 of TM1 traditional medicine at ICD-11, and it is likely that future revisions will include TM2 (Ayurveda) and TM2 (homeopathy), which are also unproven effective and obscure practices. WHO has framed itself diplomatically and defended its decision to include it as a tool for statistical diagnostics and classification purposes and to be used in conjunction with standard medical practices and to help determine the effectiveness and safety of traditional practices.

Ineffective practices and the exploitation of nature contribute to disaster

All of these practices - from the use of animal parts in medical practices that have no single attribute of efficacy, safety and justification to breeding for meat, fur or for medical purposes - contribute to the epidemiological problems we are witnessing today.

People are exploiting the wild world too much and with their activities - building settlements, making plantations, intensively breeding domestic animals - they create more opportunities for wildlife to contact ours, which are the conditions that are a true recipe for disaster. In doing so, there is a possibility that some wild animals, such as bats, will be anathematized and exposed to killing only because they are potential reservoirs of a particular pathogen. This would be unacceptable because it is only us and it is our fault that the penetration of our civilization into the wild has created such opportunities for the spread of the virus.

This article I published first on Voice of America Bosnian service. Translated by Jonas Helgason.