title: Characteristics and practices of Traditional Chinese Medicine retail shops in London, UK: A cross-sectional study using an observational approach.
abstract: BACKGROUND
  Traditional Chinese Medicine (TCM) is a popular form of ethnomedicine in the UK, and is accessed by Western, Chinese and other ethnic groups. The current regulatory regime does not effectively protect the public against poor-quality and unsafe TCMs. Understanding ethnopharmacological information on how TCM is promoted and practiced may help to inform initiatives aimed at ensuring the safe use of TCMs in the UK, and put laboratory-based ethnopharmacological investigations of TCMs in a broader context.
  
  
  OBJECTIVE
  This study aimed to examine the characteristics and practices of TCM retail outlets in London, UK, and to identify factors relevant to the safe use of TCM in the UK.
  
  
  METHODS
  TCM retail outlets ('shops') in London, UK, were identified using a systematic approach. A structured questionnaire including questions on shop business type was used to recruit participant shops. Shops consenting to participate were visited within six weeks of providing consent. A piloted semi-structured questionnaire on shop characteristics was used for data collection following observation. The British National Formulary 53 was used to classify medical conditions/uses for TCMs promoted in the shops. Data were stored and analysed using MS Access 2003, MS Excel 2003 and SPSS 13.
  
  
  RESULTS
  In total, 54 TCM shops in London were identified, of which 94% offered TCM consultations with a TCM practitioner. Detailed characteristics were described within 35/50 shops that gave consent to observing their premises. Most shops labelled and displayed over 150 Chinese Materia Medica (CMMs; crude materials, particularly herbs) for dispensing after consultations with a TCM practitioner. Medical conditions/uses and Patent Chinese Medicines (PCMs) were commonly promoted. In total, 794 occurrences of 205 different medical conditions/uses (median=32, QL=19, QU=48) were identified. These conditions/uses most commonly related to the following therapeutic systems: central nervous system (160/794, 20.2%); musculoskeletal and joint disease (133/794, 16.8%); obstetrics, gynaecology, and urinary-tract disorders (122/794, 15.4%); skin (102/794, 12.9%); gastrointestinal system (62/794, 7.8%). Specific conditions/uses that were frequently promoted included eczema (19/23 shops, 82.6%), arthritis (18/23, 78.3%), acne (17/23, 73.9%), obesity/weight loss/slimming (17/23, 73.9%) and psoriasis (17/23, 73.9%). Claimed conditions/uses included some serious medical conditions (e.g. diabetes, cancer and hypertension) and those focusing on vulnerable groups (e.g. children's diseases and pregnancy treatments).
  
  
  CONCLUSIONS
  TCM shops in London, UK, typically displayed names of a wide range of medical conditions/uses for TCMs using readily understandable medical terms, implying TCM can be used to prevent or treat these conditions. However, many of these advertisements did not comply with UK regulations on medical claims for herbal medicines. Future studies should explore how these advertisements influence consumers' decisions to access TCM in the UK, practices of TCM shop staff towards the supply of TCMs in the UK, and what are the health implications at the individual and population levels.
authors.affiliation: Centre for Pharmacognosy and Phytotherapy, School of Pharmacy, University of London, 29/39 Brunswick Square, London WC1N 1AX, UK. Electronic address: lida@nihs.go.jp.
authors.forename: Lida
authors.initials: L
authors.lastname: Teng
authors.affiliation: Medical Toxicology Unit, Guy's & St Thomas' Hospital Trust, Avonley Road, London SE14 5ER, UK. Electronic address: debbie_shaw@talk21.com.
authors.forename: Debbie
authors.initials: D
authors.lastname: Shaw
authors.affiliation: School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand. Electronic address: j.barnes@auckland.ac.nz.
authors.forename: Joanne
authors.initials: J
authors.lastname: Barnes
mesh_terms: D003132:Commerce; D003257:Consumer Product Safety; D004348:Drug Labeling; D006801:Humans; D008131:London; D008516:Medicine, Chinese Traditional
keywords: Chinese Materia Medica (CMM); Commerce; Cross-sectional study; Ethnopharmacy; Patent Chinese Medicine (PCM); Traditional Chinese Medicine (TCM)