Qi Spot

Chinese Herbs

A few days ago, I blogged about an article entitled “Evidence lacking for Chinese medicine in diabetes“.  That website article commented that, based on a Cochrane review of literature, the evidence for using Chinese Medical substances to treat Diabetes Mellitus is rampant with bias and lack of double-blind studies.  To be precise, the study (http://www.cochrane.org/reviews/en/ab006690.html) says:

This review examined 16 trials lasting four weeks to two years involving 1391 participants receiving 15 different Chinese herbal medicines in eight different comparisons. No trial reported on mortality, morbidity or costs. No serious adverse events like severe hypoglycaemia were observed. Meta-analysis of eight trials showed that those receiving Chinese herbal medicines combined with lifestyle modification were more than twice as likely to have their fasting plasma glucose levels return to normal levels (i.e. fasting plasma glucose <7.8 mmol/L and 2hr blood glucose <11.1 mmol/L) compared to lifestyle modification alone (RR 2.07; 95% confidence intervall (CI) 1.52 to 2.82). Those receiving Chinese herbs were less likely to progress to diabetes over the duration of the trial (RR 0.33; 95% CI 0.19 to 0.58). However, all trials had a considerable risk of bias and none of the specific herbal medicines comparison data was available from more than one study. Moreover, results could have been confounded by rates of natural reversion to normal glucose levels.

And it concludes that:

The positive evidence in favour of Chinese herbal medicines for the treatment of IGT or IFG is constrained by the following factors: lack of trials that tested the same herbal medicine, lack of details on co-interventions, unclear methods of randomisation, poor reporting and other risks of bias.

This is the kind of weasel wording and double-sided language that makes me proud to be a western MD.  (Oops, that sound you heard was the sarcasm meter going off the charts.)  You get good results, but results that are damaging to Big Pharma, and the establishment looks for ANY excuse to put it down.  “Moreover, results could have been confounded by rates of natural reversion to normal glucose levels,” they say.  PFSHAW.

But one thing I love more about weasel wording is that it enables any journalist to write the article on the study in any way the writer sees fit.  The previous article from endocrinologyupdate.com.au presented the results in a negative light.  The article I am citing below presents the SAME study in a positive light!

Here is an excerpt from the article (http://ghanabusinessnews.com/2009/10/15/chinese-herbs-may-have-cure-for-diabetes/):

Chinese herbs may have cure for diabetes

A number of traditional Chinese herbs may help control blood sugar levels in people at high risk of diabetes, a new research review suggests.

The review, which examined 16 clinical trials of 15 different herbal formulations, found that the herbs generally helped lower blood sugar levels in people with “pre-diabetes” — those with impaired blood-sugar control that can progress to full-blown type 2 diabetes.

When the researchers pooled data from eight of the studies, they found that adding an herbal remedy to lifestyle changes doubled the likelihood of participants’ blood sugar levels returning to normal.

What’s more, people using the remedies were two-thirds less likely to progress to diabetes during the studies, which ran for an average of nine months.

The findings appear in the Cochrane Library, which is published by the Cochrane Collaboration, an international organization that evaluates medical research.

The results, say the researchers, are “quite promising.” However, they also stress that the studies had shortcomings in their methods that make it hard to draw firm conclusions.

Wow, change the wordings a bit, alter the sequence of ideas, choose what quotes to publish (as we’ll see below) and you can change an article from “Evidence lacking” to “May have cure for diabetes”.  Oh I am BEAMING with PRIDE! It just makes you wonder just how reliable these journalists are in reporting research findings.  For all we know we are just being FED what Big Pharma wants us to know.

Now, both articles bemoaned the lack of double-blinding.  The first article actually made it seem like a mortal sin.  What this article reveals is that a quote from lead researcher Suzanne Grant (albeit through an email to Reuters Health) reveals that the researchers were in fact aware of WHY double blinding is difficult.  I quote while emphasizing the good part:

“There are a lot of herbal medicine products on the shelves, but few have been subjected to a rigorous trial,” lead researcher Suzanne J. Grant, of the Center for Complementary Medicine Research at the University of Western Sydney, in Australia, told Reuters Health in an email.

Many of the trials her team examined, she explained, had a “high risk of bias” that can overestimate the effects of the treatments.

The gold standard for proving a treatment’s efficacy is a clinical trial where participants are randomly assigned to receive either the real treatment or a placebo, with both the researchers and participants unaware of who is taking the real drug.

Grant’s team found that those processes were often absent or not clearly detailed in the trials they reviewed.

So, she said, there is still a need for more rigorous trials before any herbal product can be recommended for diabetes prevention.

The studies included a total of 1,391 men and women with either impaired glucose tolerance or impaired fasting glucose — problems in blood-sugar control that lead to sugar levels that are elevated, but not high enough to diagnose diabetes.

The studies tested various Chinese herbal mixes traditionally used for blood-sugar control — products like Jiangtang Bushen, Xiaoke huaya and Tang Kang yin.

In most trials, the products were added to lifestyle changes and tested against the effects of lifestyle changes alone — though the specific changes were not detailed in most reports.

Grant suggested that if people with pre-diabetes do want to try an herbal product, they first consult their doctor and, ideally, take any herbs under a guidance of a health provider qualified in herbal medicine.

She pointed out that in traditional Chinese medicine, herbs are recommended based on individuals’ unique situations, and not as a one-size-fits-all prescription.

As far as safety, the review found no serious side effects attributed to the herbal products. However, Grant noted, like all medicines, herbs have the potential for unexpected side effects or interactions with other drugs.

Nuff said.  Maybe some western doctors will see that as a source of problems.  We see the customization of treatment as the strength and unique advantage of Chinese Medicine.  The problem is, the only customization I see in western medicine is customizing study results to fit vested interests.

Sources:

Corderoy, Amy. “Evidence Lacking in Chinese Medicine for Diabetes” Endocrinology Update 8 October 2009. 15 October 2009 <http://www.endocrinologyupdate.com.au/article/evidence-lacking-for-chinese-medicine-in-diabetes/501343.aspx>

Grant SJ, Bensoussan A, Chang D, Kiat H, Klupp NL, Liu JP, Li X.  Chinese herbal medicines for people with impaired glucose tolerance or impaired fasting blood glucose. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006690. DOI: 10.1002/14651858.CD006690.pub2.  First online 7 October 2009.  15 October 2009 <http://www.cochrane.org/reviews/en/ab006690.html>

Reuters Health. “Chinese Herbs May Have Cure for Diabetes” Ghanabusinessnews.com 15 October 2009.  15 October 2009 <http://ghanabusinessnews.com/2009/10/15/chinese-herbs-may-have-cure-for-diabetes/>