Dear Duncan and all,
It think it is an objective and factual acknowledge that traditional medicine has a great potential in managing conditions that may have limited solutions offered by biomedicine. Traditional medicine and evidence-based medicine is not mutually exclusive but rather interconnected and complementary. The emphasis on traditional medicine is on the identification of possible solutions from a different perspective with follow-up assessment and validation. For sure we need rigorous clinical assessment similar to biomedicine.
I think it is quite obvious that the conventional mode of drug development has limitations - we are having a diminishing economic return and impact of biomedical research (1,2) and disconnected findings between in vivo and in vitro experiments and clinical application. (3-7) Registry-based efficacy-driven approach clinical research may provide a more efficient mechanism for developing strategies. (8) Many traditional medicines have a long history of use and some of them even have a systematic electronic record (eg Taiwan). Why not utilizing the existing resources to look for a quicker candidate for clinical evaluation?
Furthermore, if multiple high quality registry-based big data studies showed the efficacy of certain traditional medicine in long-run, is a RCT with limited duration and recruitment criteria absolutely necessary? I think we need a revisit in evaluation methodology, not only for traditional medicine but for medicine in general.
1. UK life science research: time to burst the biomedical bubble. Lancet. 2018;392(10143):187.
2. HM Government. Industrial Strategy. London: HM Government; 2017
3. Sandercock P, Roberts I. Systematic reviews of animal experiments. Lancet. 2002;360(9333):586
4. Pound P, Ebrahim S, Sandercock P, Bracken MB, Roberts I. Where is the evidence that animal research benefits humans? BMJ. 2004;328(7438):514-7.
5. Hackam DG, Redelmeier DA. Translation of research evidence from animals to humans. JAMA. 2006;296(14):1731-2
6. Roberts I, Kwan I, Evans P, Haig S. Does animal experimentation inform human healthcare? Observations from a systematic review of international animal experiments on fluid resuscitation. BMJ. 2002;324(7335):474-6.
7. Perel P, Roberts I, Sena E, Wheble P, Briscoe C, Sandercock P, et al. Comparison of treatment effects between animal experiments and clinical trials: systematic review. BMJ. 2007;334(7586):197.
8. Tang J-L. Research priorities in traditional Chinese medicine. BMJ. 2006;333(7564):391-4.
HIFA profile: Chris received training in biomedical science, clinical Chinese medicine, public health and basic science from Hong Kong Baptist University, London School of Hygiene & Tropical Medicine and the University of Hong Kong. He is currently a research clinician based in Hong Kong and has been actively engaged in clinical medicine, clinical trial, basic science research and qualitative research. He had served for Hospital Authority, World Health Organisation, KPMG, NGOs and hospitals on research consultancy, medical administration and clinical medicine in Hong Kong and mainland China before his academic engagement.