China to Ease Regulations on Traditional Medicine Scientists Fear Plans to Abandon Clinical Trials of Ancient Remedies Will Put People at Risk

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announced a rise in R&D tax credits (from disciplines, increasing numbers by at least ‘sector deals’ with industry to drive productiv- 11% to 12%) in the budget. 200 places a year by 2020–21. ity in areas such as the life sciences. It is likely The industrial strategy picks out specific Other measures likely to directly affect aca- that the government will not have enough areas on which to splash the cash. In particu- demic scientists include a promised boost to capacity to manage them all internally, says lar, it identifies four ‘grand challenges’ in high- a stream of funding that is allocated directly Kieron Flanagan, a science-policy researcher at tech fields: artificial intelligence (AI) and big to universities, and spent at their discretion. the Alliance Manchester Business School, UK. data; clean growth; the future of mobility; and This funding is crucial for blue-skies and basic Flanagan thinks this will ultimately put greater meeting the needs of an ageing society. These research, but has remained largely unchanged responsibility into the hands of UK Research areas will benefit from an additional £725 mil- since 2010. An unspecified fund is also prom- and Innovation (UKRI), an organization that lion over the next 4 years from the Industrial ised to support multi- and interdisciplinary from 2018 will consolidate the activities of nine Strategy Challenge Fund (ISCF) — a cash pot research: an idea proposed in a 2015 review by existing UK funding agencies. If the organi- that has allocated £1 billion since its launch last Nobel laureate Paul Nurse. zation ends up steering the direction of more year. Meanwhile, £45 million will be spent to The strategy mentions a plethora of tech- industrial R&D, “it makes UKRI a uniquely support more PhD students in AI and related nology-based schemes, including unspecified powerful beast”, he says. ■

HEALTH China to ease regulations on traditional medicine Scientists fear plans to abandon clinical trials of ancient remedies will put people at risk.

BY DAVID CYRANOSKI The Chinese government has been forcefully TCMs after about ten people fell ill with fevers promoting TCMs as an alternative to expen- and chills. upport for traditional medicine in China sive Western drugs. Doctors of Chinese Less than a month later, on 18 October, goes right to the top. President Xi Jinping medicine have welcomed the new policy, say- researchers in Singapore and Taiwan pub- has called this type of medicine a “gem” of ing that it will make it easier for companies that lished a study in Science Translational Medicine Sthe country’s scientific heritage, and promised produce such medicines to get drugs approved linking liver cancer to aristolochic acid, an to give alternative therapies and Western drugs and make them available to patients. Lixing ingredient widely used in traditional remedies1. equal government support. Now the country is Lao, director of Hong Lead author Steven Rozen, a cancer-genomics taking dramatic steps to promote these cures “Few doctors Kong University’s researcher at Duke-NUS Medical School in even as researchers raise concerns about such would dare to School of Chinese Singapore, is convinced that aristolochic acid treatments. publicly criticize Medicine, says that contributed to the mutations in the cancer From early next year, traditional Chinese although traditional cells, but says it’s harder to determine to what medicines (TCMs) may no longer be required traditional medicines will no extent it caused the tumours. to pass safety and efficacy trials in humans Chinese longer need to go Aristolochic acid has also been linked to in China. Draft regulations announced in medicines.” through clinical tri- cancers of the urinary tract and can cause October by the China Food and Drug Admin- als, the CFDA will fatal kidney damage2,3. Rozen says that it is istration (CFDA) mean traditional medicines still require remedies to undergo preclinical still in common use, despite warnings from can skip such costly and time-consuming trials pharmacological testing and drug-toxicity the US Food and Drug Administration that as long as manufacturers prepare ingredients studies in animals or cells to gain approval. it is associated with kidney disease. “It would using essentially the same method as in classic But scientists say that safety concerns be a good time to reassess regulations” of Chinese formulations. The State Adminis- continue to plague the industry, and that aristolochic acid, he says. tration of Traditional Chinese Medicine and minimizing clinical-trial requirements could Lao sees people take remedies containing the CFDA will compose a list of the approved put more people at risk. On 23 September, aristolochic acid every day, and says it should methods. the CFDA recalled batches of two injectable not cause problems if taken “moderately and

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Some formulations used in traditional Chinese medicines have been developed over thousands of years.

to treat diseases”, rather than as a regular development of TCMs, called it biased and supplement. He says more research is needed demanded an apology. into how to ensure the safe use of the potentially As well as reducing regulations for toxic substance. Overall, Lao is not concerned TCMs, the Chinese government has made about safety issues with traditional medicines it easier for someone to become a doctor because “unlike Western drug development, of traditional medicine and for hospitals these herbal formulas have been used for that use the approach to open. Since July hundreds and thousands of years”, he says. 2017, students studying traditional medi- But Li Qingchen, a paediatric surgeon at cine no longer need to pass the national the Harbin Children’s Hospital and a well- medical exams based on Western medicine. known critic of TCMs, says the recent recalls of Instead, traditional-medicine students can remedies show that current safety measures attend apprenticeship training and pass a skills aren’t adequate. He says doctors need to inform test. And practitioners who want to open a the public about some of the dangers associ- clinic no longer need approval from the CFDA. ated with traditional medicines, but that most They need only register with the agency. are unwilling to speak out against them. “Few The government’s ultimate goal is for all doctors would dare to publicly criticize TCMs,” Chinese health-care institutions to provide he says. Li thinks that the government’s pro- a basic level of TCMs by 2020. A road map motion of TCMs will make it harder for scien- released in February 2016 by the State Council, tists to criticize the drugs “because the matter China’s highest administrative body, plans to gets escalated to a political level and open dis- increase the number of TCM-licensed doctors cussions become restricted”. to 4 per 10,000 people, an increase from fewer than 3 practitioners per 10,000 people. The CRITICISM MUTED government also wants to push TCMs’ share With strong government support for the of pharmaceutical sales from 26% to 30% by alternative-medicines industry, Chinese cen- the end of the decade. ■ sors have been quick to remove posts from the 1. Ng, A. W. T. et al. Sci. Transl. Med. 9, eaan6446 Internet that question the efficacy of TCMs. (2017). On 23 October, an article on a medical news 2. Vanherweghem, J.-L. et al. Lancet 341, 387–391 site that called for closer attention to be paid to (1993). 3. Lord, G. M. et al. Lancet 358, 1515–1516 (2001). the risks of aristolochic acid was removed from social-media site WeChat. The story had been viewed more than 700,000 times in three days. CORRECTIONS Debate over TCMs has been silenced The News story ‘Hungary rewards before in China. Last year, a Beijing think success’ (Nature 551, 425–426; 2017) tank — the Development Research Center understated the funding for the Hungarian of the State Council — proposed banning the Brain Research Programme. It received practice of extracting Asiatic black bear bile, 18.5 billion forints, not 18.5 million. another common ingredient in TCMs. The And the News story ‘Science scrambles think tank’s report questioned the remedy’s after storm’ (Nature 551, 282–283; 2017) efficacy and suggested using synthetic alter- erred in its description of karst. Karst is not natives. It was removed from the think tank’s a type of rock formation, but a variety of website after the China Association of Tradi- landscape formed by the erosion of rock. tional Chinese Medicine, which supports the