The Huiyang district is what the locals describe as a “2nd level city” (a fairly undeveloped and rural one) that is host to some 558,000 people.
---An aerial view of the Huiyang District
Although I have called this a rural city, you can still find many modern amenities that any sufficiently large city would hold. However, even in this large city, it is difficult to find modernized, western medical care. Many former ex-patriots like myself have to travel to a place like Hong Kong, a massive westernized city, to get suitable medical attention. When I lived in Shanghai, I had a friend who had to be flown by helicopter to Hong Kong after a bite from a feral dog, as no acceptable hospitals could be found in my city. This is what we are dealing with. In Huiyang, by far the most prevalent and used medicine is that of the traditional Chinese and herbal kind practiced in family run clinics. The closest comparison to these many clinics would be to a Walgreens or CVS pharmacy, however with many notable exceptions which we will get to later on.
Before I begin, I have to make my intentions clear. My goal here is not to characterize the whole of China by what I found in my short stay. However, by seeing just how easy it is to find pseudoscience, we might be able to compare China and the US. For example, if you are looking for it like I was, it is immediately apparent that pseudoscientific shops, practitioners, and advertisements are much more visible on the streets of China than they are in the US. Turn a corner and you will see another reflexology-based foot massage parlor or powdered herb purveyor.
---Sign for reflexology-based massage
Again, though it would be hard to disagree with an argument stemming from this observation, being true to the scientific method, we can’t say anything definitively without more data points. More data is hopefully what we will have by the end of this journal.
My other goal is to get up close and personal with the pseudosciences that we as skeptics so routinely rally against. I will, to the best of my ability via a translator, ask questions of those who sell the products and services that I find, not only discovering the rationales behind their function but also connecting with the believers themselves. Through interviews and pictures, some conclusions will hopefully present themselves, and the whole exercise will prove interesting.
Dirty Needles, Snake Ribs, and Cigarettes
Much of the information that I gained on this trip was from a traditional Chinese herb practitioner who I visited and interviewed. His clinic was located in a small village outside of Huiyang. The first thing that I noticed about the clinic was its surroundings and exterior.
---Area of the city surrounding the medicine clinic
---The exterior of the medicine shop
Far from being located in a city center, the clinic was nestled among dilapidated apartment buildings and dirt alleyways. When I walked in with my translator, the “doctor” and his son who ran the “pharmacy” warmly greeted us.
As a white westerner, I am quite used to these kinds of encounters in China, and the word “warmly” more describes looks of confused excitement from seeing a young white kid than it does a tight embrace. And as the operator of a small village clinic in rural China, he was very exited to get his picture taken with me.
---The “doctor” and myself
Like the exterior, the interior of the clinic was about as unhygienic for a clinic as you could imagine. Patients were smoking, layers of dust clung to the windows and fans, and dead insects were gathered in convenient piles in the corners of the room.
---The interior of the clinic
After surveying the small front room, I then asked the “doctor” (these scare quotes will be explained below) to show me to the room where all of the herbs were held, which is pictured below.
---Shelves of herbs and medicines
---You’d be surprised what you can find here
The son who handled the procurement of these herbs quickly began opening up all the most expensive jars (which treated the most exotic illnesses, apparently). What I found in them was about as far from a Walgreen’s pharmacy as you could expect. Jars of dried insects, reptiles, vegetables, and fruit lined the shelves. Looking at the pictures, remember that all of these are supposed to be ingested in some way, curing ailments from stroke (I am not sure what this means, the doctor was vague on this point) to indigestion.
---Mini coiled snakes
---Container of scorpions
---Bag of sawfish?
---Assorted snake ribs
---Gliding lizards on sticks
---Massive centipede on a stick (minus legs)
--- Dried opium poppy
Still not done in the herbal closet, I then examined the hardware with which the medicines are prepared. No laboratories here, just simple implements. Sterile, this was not.
---The prescription axe
It must be said that while I am aware that all of these herbs are sealed within containers and seem harmless, the preparation, storage, and overall medical competency was appalling. No washing of hands was observed before or after herb handling (indeed, no concern for cleanliness was the name of the game), no expiration dates or regulatory information were visible on the containers, no sterile preparation tools were used, no cleaning of the containers or the shelves they occupied was done, nothing that would assure me that I would get a sound treatment from this clinic. The doctor was a very nice man and enthusiastic to talk to me, but it was clear that the whole clinic was a few centuries behind medical science.
---Notice the cigarette
---The doctor removes the acupuncture needles from the patient. The large welts that you can see are from the cupping procedure.
I stuck around until the doctor was finished with the procedure, with which the patient was not entirely satisfied. After removing the needles the doctor gave the patient a thorough neck massage. This slight detail seems innocuous enough, but it makes me wonder from which the patient is receiving benefit, the massage or the needles (the science would suggest the massage). This is something that was of course unrecognized by either the doctor or the patient. Another small point which I think can give you a better idea of the state of medicine in this clinic: the needles that were inserted into the patient were neither sterilized before or after insertion and were stored for later use in an empty cigarette tin.
---Cigarette tin/needle receptacle
Now done with the patients that he was seeing, the doctor, my translator, and I sat down for some green tea and an interview.
A Cure for Everything, Unless It Is Really Bad
While some may have already made up their minds as to what Chinese herbs and other treatments are all about, I could not let an opportunity to learn from a traditional practitioner pass me by. The following conversation is an attempt to get to the root of Chinese medicine and to hopefully determine the state of medicine in China.
The following conversation must be considered appropriately, as my note taking was via paraphrasing and all responses from the doctor had to be first translated. I also apologize for the short responses, but the doctor was rather curt and the translator I suspect distilled many of his answers. Even so, the picture of medicine in China after this interview became much more clear to me, and it seems as though skeptics in the US have it easy.
As a medical practitioner, are you worried about your smoking affecting your health?
Do you get a lot of your knowledge from these books?
Yes, I routinely perform the same practices that are in these books.
Would it be fair for me to say that much of the medicine in China is like what we found in this clinic?
There are many more of these clinics than there are hospitals in China. As a whole, clinics like these characterize Chinese medicine.
Thoughts on the Clinic
1. It is hard to accept the fact that people come to a place for disease treatment that lacks even basic concerns based on medical science. The lack of sterilization and cleanliness is particularly egregious.
2. I am not surprised that people keep coming back to clinics like this one. Unless the disease is really bad (which will unfortunately lead to death for many patients, as they do not have the resources to travel to a hospital or pay for the care), herbs could subjectively relieve symptoms via the placebo effect. Acupuncture “works” in a similar way. Even though the patients are simply living with the disease or unknowingly letting it run its course, herbal remedies are assumed to work because of confirmation bias. For example, because the common cold will naturally ebb and flow in nastiness and eventually dissipate, it is obvious that sometime after taking an herb the cold will vanish. Though not the work of the herb, the patient will assume that the herb was their saving grace, and not a natural attenuation. This simple cognitive misstep keeps the entire herbal enterprise (of the kind I saw) afloat. Furthermore, given that “herbs can take months to work,” the herb will supposedly vanquish any ailment that naturally dies out or lessens in severity in that period. This only extends the goal posts wider.
3. If there were one rule that we could make about good, science-based doctors who are legitimately concerned about health, it would be that they should not be smokers (or should at least discourage it). If medical science can agree upon one thing, it is that smoking is harmful to your health and those around you. Seeing a medical practitioner smoke in front of you cannot help but make you skeptical of their concerns and education, especially if they (and all their patients) are free to smoke in their medical establishment.
4. The Dao Shi’s explanation of why smoking is OK for your health really hit the point home for me. His explanation was one that wrapped up confirmation bias, anecdotal evidence, confused ideas about correlation and causation, and objectively incorrect ideas about the dangers of smoking into an answer that informed me about the scientific reasoning that accompanies the herbal practice. Far from being based in science, it is rather based on word of mouth, subjectivity, and conjecture about the workings of the body.
5. Every medical practitioner has referenced a medical textbook for help, I’m sure, but I doubt that the textbook was over a century old. Using this passed down knowledge is like playing the children’s game “Telephone” (where the first child is told a phrase and relates what is said to the next child, often distorting the phrase far beyond the original by the end) with medical knowledge. The fact that the Dao Shi told me that many of his practices come straight out of such ancient tomes should speak for itself.
6. The Dao Shi, as a medical practitioner, showed little scientific knowledge or thinking. Many explanations I received were based on anecdote, confirmation bias, or flat out nonsense like herbs relieving “fire,” restoring “balance,” or curing cancer. If this characterizes most of the clinics in China, as my translator stated, then the situation for medical science is fairly dire.
7. It should also be mentioned that the clinic had a small section that sold western medications like Tylenol. However, even though this is a good thing, the Dao Shi that I spoke to had little or no education in pharmacology (admittedly). I fear that this section of the clinic employs a “take some of this, whatever it is” mentality towards western medication.
The State of Medicine in China
If we can trust what I found to characterize much of the medicine that is practiced in China, which I believe we have a good reason to, then we can say that China has a lot of catching up to do. Given, China is about to outpace the US in terms of scientific papers published and obviously has very reputable medical research taking place within its borders, but even this research on the frontier of medicine has not wrestled control from pseudoscientific belief systems. In a country that is largely comprised of rural areas and lower class workers (China is absolutely huge and the major cities are but a small percentage of that area), the traditional medicines, and the beliefs that surround them like “chi” and acupuncture “meridians” remain more popular and more valued than western medicine. The scientific elite in China may be making great strides, but this has yet to find its way into a public that greatly values its tradition, medical beliefs included.
Many of the medical practices that I found, indeed the attitudes of the country toward traditional medicine, are based solely on arguments from tradition and antiquity. China has a wonderfully interesting history and strong traditional convictions, and I think that this has pervaded its practice of medicine. As eastern medical practices (the ones that are scientifically implausible or impossible) are continuously exported to the gullible west, we are then taking part in the largest logical fallacy in the developed world. It cannot be more clearly stated: just because something has traditionally been used or been used for a long time does not mean that it works. Chinese herbs have been utilized for medical purposes for centuries, but this fact is of no scientific value. Science may find a molecule in an herb that is useful, but this will result from increased study, not blind assertions of efficacy. For example, the medical literature on acupuncture is clear: it does not work beyond placebo. No amount of anecdotal evidence can prove otherwise. However, this clearly has not stopped acupuncture from being outrageously popular in China.
Regrettably, the widespread acceptance of baseless medical practices in China has conferred acceptance from the government. I am not sure whether or not the government simply accepts the fact that the people want to use these medicines and just deals with it through regulation, is trying to phase is out, or outright supports it, but as it stands right now the government condones these practices (if we look at the large number of acupuncture and herbal medicine licensures, for example). By contrast, I would be surprised if the US government did not immediately shut down an herbal clinic that sold people products explicitly to treat disease, especially if it was in the kind of state the one I visited was in. Not only is a dirty, smoke-filled, herbal clinic in China able to sell products to treat disease, it receives licensure from the government. This, if anything, is a strong indicator of the attitude towards medicine in China.
---Herbal shops on the streets of Huiyang
The beliefs that underlie the use of herbal remedies and traditional Chinese medicine seem so ingrained into Chinese culture that I cannot even begin to think how they could be successfully debunked. These medicines have the weight of thousands of years worth of acceptance, and additions from medical science less contradict this weight than they do merely add to number of treatment options. Governmental acceptance, ingrained traditional belief, and substantial presence of traditional clinics all paint a rather bleak picture for the skeptic. Again, I am not saying traditional treatments are the only ones available to the Chinese, far from it, I am saying that in China the portrayal of traditional medicine is much more akin to how science-based medicine is viewed (whereas in the US they are deemed “controversial” or “alternative”), which is the problem. You can find very good science-based doctors in China, no doubt about it, but you can find just as many if not more traditional and herbal practitioners vying for primacy over them.
---Pharmacy shelves lined with herbal and traditional products
This was my own personal experience and is of course open to refutation. I did not have the time or the opportunity to see as many shops or speak to as many people as I would have liked to. It is true that I went looking for pseudoscience and avoided western clinics and hospitals, but from what I saw on my trip, most of the clinics are essentially similar to this one. From what I saw, the herbal clinics and traditional medical beliefs are mainstream enough to produce an almost alien medical landscape (to me, the American skeptic). If anything, these observations should galvanize all skeptics to work diligently and relentlessly for the cause of science-based medicine with hope that the time will come when treatments for cancer will not involve crushed scorpions.
Kyle Hill is the newly appointed JREF research fellow specializing in communication research and human information processing. He writes daily at the Science-Based Life blog and you can follow him on Twitter here .