Is China the World Leader in Biomedical Fraud?

In 2015, a 6-year-old diabetic child died in Australia. Instead of giving him insulin, his parents had taken him to Hongchi Xiao, an itinerant self-proclaimed healer who performs “slap therapy” — known as paida lajin in traditional Chinese medicine. As the name implies, the child was slapped in an attempt to cure his illness.

This isn’t the first death to which Xiao, who runs workshops all over the world, may have contributed. A 71-year-old British woman, also a diabetic, died in October 2016 after attending one of Xiao’s workshops in England. According to the Sydney Morning Herald, Xiao has been charged with manslaughter in the boy’s death, along with the child’s parents and grandmother.

These deaths are horrifying because they were entirely predictable and preventable. Yet, if the Chinese government has its way, the world will see many more of them.

Traditional Chinese medicine is deeply embedded in the culture of contemporary mainland China. As Foreign Policy’s Asia editor, James Palmer, wrote for Aeon in 2013, it is not simply a matter of a few medical holdouts clinging to the remnants of a long-forgotten tradition. On the contrary, traditional Chinese medicine is thoroughly institutionalized: Every major city has a traditional medicine hospital and university. A special government department exists to administer it, and the traditional Chinese medicine industry is a massive business. Its advocates in the West often contrast its supposed purity to the pharmaceutical industry, but in China traditional medicine is Big Pharma.

To grasp the scope of this problem, imagine that every major European city had a university that taught that the Earth is flat and merely 6,000 years old and a hospital that practiced bloodletting and aura cleansing. And then imagine that health professionals across Europe didn’t see much difference between prescribing Viagra for impotence or horny goat weed. Citizens would rightfully complain that their universities were teaching nonsense and their doctors were practicing witchcraft.

But this is standard operating procedure in China. Although some traditional practices are centuries or millennia old, there is little evidence to support the vast majority of them. When scrutinized in clinical trials — the gold standard for the testing of medical therapies — most traditional practices, such as acupuncture, fail. At best, traditional Chinese therapies might trigger a placebo effect; at worst, they can cause severe side effects, despite a widespread belief in China that traditional medicine is inherently harmless.

And yet, Chinese President Xi Jinping wants to share these placebos with the world. The Economist reported that Xi wants traditional Chinese medicine to be given equal status with “Western medicine.” By 2020, he wants all 1.4 billion Chinese people to have easy access to it. Worse, the Chinese government is spreading traditional Chinese medicine across the globe, including in the United Kingdom and the United States, by subsidizing branches of the Confucius Institute that teach traditional medical techniques in addition to courses on Chinese language and culture. Due to their potential for spreading Chinese government propaganda, Confucius Institutes in the United States are now being monitored by the FBI.

Traditional Chinese medicine has a long history as propaganda. The modern concept of it originated in the 1950s under Mao Zedong, at a time when cultural pride and foreign-directed propaganda demanded the invention of a powerful Chinese tradition. The range of traditional Chinese healing practices was sold as “scientific” to gullible foreigners and the Chinese public alike. In a still desperately poor country, traditional medicine was better than nothing for the masses.

Now, traditional healing has been mixed with the Chinese Communist Party’s new determination to promote the country’s cultural supremacy around the world, in opposition to the dangerous lures of Western influence. Xi has demanded that government institutions promote “cultural confidence.” With most other forms of China’s premodern culture destroyed by the ravages of Maoism and modern-day materialism, traditional Chinese medicine stands almost alone among the ruins.

One may be tempted to believe that if patients are still given modern medicine, traditional medicine is simply a harmless “add-on” — like a stuffed animal or bouquet of flowers — that might make people feel better. But that is a dangerous conclusion. Traditional Chinese medicine thrives, in part, because charlatans encourage the public to be suspicious of modern medicine. Similar fraudulent claims have already resulted in catastrophe. Andrew Wakefield, the British medical doctor who faked a study linking vaccines to autism, is the primary culprit behind the falling vaccination rates in the developed world. As a result, outbreaks of measles and other vaccine-preventable diseases have occurred. In 2017, measles cases in Europe spiked 400 percent.

The threat does not end with infectious diseases. Cancer patients who reject modern treatments such as chemotherapy in favor of alternative medicine are likelier to die. The Journal of the National Cancer Institute reports that seven years after diagnosis, nearly 75 percent of cancer patients using conventional medicine were still alive, while the figure for alternative medicine patients was merely 50 percent.

Thus, the world can ill afford to turn its back on modern medicine. If China wishes to play a leading role in biomedical science, it should be embracing modern medicine, not fanning the flames of suspicion against it. Real Chinese doctors already face public hostility and suspicion, especially over vaccines; by pumping up pseudoscience, the government is only hurting its efforts to persuade the public to put its trust in the state’s own health programs.

This is unfortunate, as Chinese investment in scientific research has grown substantially in recent years. In early 2017, R&D Magazine forecast that China would spend nearly $430 billion on research and development by the end of the year, amounting to nearly 21 percent of the estimated global total — a contribution second only to that of the United States ($527 billion).

That money, however, is not being put to good use. In 2010, Nature reported that “many of the country’s scientific journals are filled with incremental work, read by virtually no one and riddled with plagiarism.” A 1998 study found that Chinese scientists almost never reported negative results — a scientific impossibility. Little seems to have changed since then. Null results remain extremely uncommon in traditional Chinese medicine papers according to a 2016 study. Today, China also leads the world in retractions due to fraudulent peer review, while a survey by Chinese regulators found that about 80 percent of clinical trial data was fabricated.

China has the manpower and financial resources to make a sizable contribution to the global research community. But the country’s scientific progress is being held back by an attitude that appears to favor quantity over quality, tradition over evidence, and conformity over creativity. That is a recipe for stagnation, not success.

The promotion of evidence-based medicine is in China’s long-term interest. In a world that is increasingly skeptical of science and technology, we need national governments to embrace knowledge and the tangible benefits it brings. Xi alone cannot change China’s culture, but he could certainly use his power and influence to bring Chinese medicine into the 21st century.