Angry Doctor

Saturday, August 05, 2006

I've got that sinking feeling...

Another weekend article for angry doc to mull over in Today today. This one is titled
'It's sinking in - Traditional Chinese Medicine is gaining acceptance, but on Western medicine's terms'.

The article is rather long (and so I won't reproduce it in full here) and it took angry doc a few readings to digest, but the author's main point seems to be that acceptance of traditional Chinese medicine (TCM) into the 'mainstream' is dependent on western doctors.

Here's how her argument goes:

The author starts by telling us that cells from the herb cordyceps is being cultured in Science Park.

(But of course the fact that a herb is being produced for commercial purposes is not proof of its efficacy, just of it commercial value - it might just as well be rhino horn cells being cultured.)

This is followed by an account of a young double-degree holder who decided to become an acupuncturist because acupuncture worked for her mother.

(An admirable personal decision, no doubt, but hardly scientific evidence that all of TCM 'works'.)

The article goes on to describe how TCM is being integrated into our traditional (western) medical practice, with public hospitals having TCM centres on their premises, and more western doctors taking up TCM courses.

However, the author notes, this is not a 'full embrace' of TCM, since:

1. The Ministry of Health's position on TCM is as follows:

"There is a sizeable number of people who will use TCM whether you like it or not, and that is why the MOH needs to regulate TCM practitioners, and make sure that the practitioners are trained and are qualified to give that kind of treatment.

"That is the only reason why the MOH regulates practitioners — not because we support TCM or promote TCM. In fact, all we want to do is to make sure that people who want to use TCM use it safely."

(I won't gloat, because one can say the very same thing about western medicine, or some of the practices within western medicine.)

2. Only about 25% of western doctors accept TCM, and the rest are 'wary' and sceptical of TCM because it 'operates on the different paradigm of meridians and energy, which is foreign to Western medicine'.

The author concludes that "it's how the Western medical camp embraces TCM that will determine its future direction".

Wow. All of the sudden the 75% of doctors who do not accept TCM are guilty of preventing it from being 'fully embraced' and accepted into the 'mainstream'.

Well, if that's really the truth, then angry doc is proud to be one of those obstructionist jerks. At least in his professional capacity anyway – how I feel about TCM as a person is largely irrelevant, since I am licensed as a western doctor.

As I have mentioned before, whether TCM is accepted into the 'mainstream' or not is largely a social issue and not a medical one. A lot of people already 'use' TCM, and I don't think it bothers them an awful lot whether or not we western doctors agree with them as long as TCM works for them. Insurance companies are free to decide if they will accept claims for TCM treatment, and individual employers are free to decide if they want to accept medical leave issued by TCM practitioners. I don't have a problem with that.

What bothers me however is the author's suggestion that there should be a 'full embrace' of TCM by western doctors.

That's rubbish. (Yes, I don't usually use such strong language, but it's the weekend.)

Western doctors should be wary and sceptical of medical disciplines that operate on a different paradigm. That’s why we underwent years of study and training on foundation sciences. That's why we continue to subject new drugs, new devices, and new treatment protocols to studies and trials.

All that is not to say that all TCM therapies and pharmaceuticals do not work, or that none of TCM should be studied or integrated in our medical system. We have an existing system of testing therapies to see if they work, and TCM therapies and pharmaceuticals should be tested individually, and not accepted as a 'full' package because it has a paradigm different from our own.

I don't buy the argument that the therapies and treatments must be accepted together with the whole philosophy to work. Medicine may be an art and a science, but it is not medicine without the science. And while science is a subset of philosophy, not all of philosophy is science.

Western medicine used to come with a philosphy of 'humours', but we've left that behind. You may argue that modern western medicine comes with its own philosophy, but you don't have to believe in the concept of antibiotics for penicillin to cure your infection.

If a method of diagnosis, a modality of investigation, or a mode of treatment works, it should work regardless of whether you believe in the philosophy behind it or not.

We all should be very worried if western doctors embraced an entire medical discipline wholesale just because a lab is making a herb used by it commercially, or that one therapy in that discipline worked for one double-degree holder's mother.

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5 Comments:

  • You are correct in your observations angry doc.

    However, I think that to set a definitive conclusion on something without investigating thoroughly and getting the facts and details is another point altogether.

    There are people who reject something absolutely and finally without even knowing what the hell it is!

    I think that's a bit extreme.

    On the other hand for those who totally and completely "embrace" something without knowing what the hell it is, represents the other end of the spectrum of extremity.

    I decided to learn about it and find out for myself the details and then form my own personal opinion on it but with basis. I believe having more knowledge is better than no knowledge.

    Personally I think having more doctors know even a bit more about TCM in a "TCM culture Singapore population" would benefit the patients in advising them appropriately what they should and should not take. First principle is "Do no harm".

    By Blogger Dr Oz bloke, At August 06, 2006 9:37 am  

  • I've read that nearly half of all the cells in our body are not human - mainly bacteria (is that right? I am no doctor), and that good health is dependent on a good harmony of the human cells with the bacteria.

    Asthma, for example, had been linked to antibiotic use in infancy. Such phenomenon is probably impossible to predict with the "scientific" approach of medicine.

    It ought to be at least reasonable to believe that the current western approach may be incomplete: the sum of our human parts doesnt add up to our human whole.

    TCM approaches medicine by tackling the human body as a whole, rather than a sum of parts. With such an approach, TCM may have a simpler more elegant solution to ailments, some of the time. OTOH, I am sure TCM specialists know their limits and wouldnt hesitate to refer the patient to a western doctor if the problem is beyond them.

    By Blogger singaporean, At August 11, 2006 2:52 pm  

  • singaporean,

    Thanks for writing.

    Western medicine does not pretend to be able to answer all the questions. However, it does not mean that just because we do not have the answer to a question, anyone else who comes along with a claim for an answer will have the correct one. You still need to test the answer.

    Take for example a mathematical problem. You can't solve the equation, and then someone comes along and tells you the solution is 42. Do you accept the answer right away, or do you check his working and see if the calculations are correct?

    The answer may indeed be 42, but I believe as doctors we should check the working ourselves.

    As for TCM being holistic... well, that's a pet peeve of mine.

    Alternative medicine disciplines like to let themselves be known as 'holistic'. The assumptions here are that:

    1. 'Holistic' is better.

    2. Western medicine is not holistic, and therefore inferior.

    Neither statement is necessarily true.

    Ayurveda medicine, Therapeutic Touch, and TCM all purport to be 'holistic' because they consider the balance of energies in the human body to be precondition to health, and do not view the human body 'in parts' as western medicine does.

    But the fact is 'holistic' in Ayurveda medicine, Therapeutic Touch, and TCM are not the same things. Are Chakras, auras, and meridiens the same things? If not, then which system is correct? Which system is better?

    Being 'holistic' may be a character of that discipline of medicine, but it says nothing about the efficacy of that discipline.

    Western medicine is 'holistic'. It does not always view a patient in 'parts'. It may not tell you that your enegries are not in balance, but it does tell you that you have a bad back, high blood pressure and diabetes because you are too fat and you need to eat less. But people would rather hear that it's their energy's fault rather than their own.

    Western medicine is also holistic on a 'macro' level, or patients are viewed in their roles in their family, workplace, and society. We just don't harp on that.

    By Blogger angry doc, At August 11, 2006 5:38 pm  

  • I think all medical practices started out with trial and error, and the findings were recorded, and methods finetuned, with no doubt plenty of dead bodies.

    The difference is that traditional medicine did away with the hows and whys to focus on the big picture. Be it chakra or qi, it is just a method to simplify the approach, so you wouldnt be lost in the details.

    If that someone tells you that even though he doesnt know maths, but every time he, his father, his grandfather, his greatgrandfather and so on, used 42 as the solution, the problem is solved, wouldnt you wonder if they are onto something right?

    Just as modern physics radically improved our understand of the universe and showed that while classical physics is good for day to day uses but yet so incomplete, TCM may prove to be a manifestation of a more precise medicine that our current scientific knowhow cannot yet explain, till a medical "Einstein" comes forth.

    Anyway, here is something new on Time for you docs to chew on:


    "Kevin Lafferty, who's based at the University of California, Santa Barbara in a press release, variations in the prevalence of Toxoplasma gondii "may explain a substantial proportion of human population differences we see in cultural aspects that relate to ego, money, material possessions, work and rules."

    By Blogger singaporean, At August 12, 2006 4:08 pm  

  • Your arguments are commonly used to defend alternative medicine, and they are flawed.

    "The difference is that traditional medicine did away with the hows and whys to focus on the big picture. Be it chakra or qi, it is just a method to simplify the approach, so you wouldnt be lost in the details."

    You assume that that is the better approach, without explaining why. One can similarly argue that 'western medicines choose to find out how exactly and why, so we can discover the underlying principles and apply them more broadly, and we focus on each individual detail so that nothing is missed' without offering any reason why this may be a better approach.

    Let us not argue on rhetoric, but on evidence.

    "If that someone tells you that even though he doesnt know maths, but every time he, his father, his grandfather, his greatgrandfather and so on, used 42 as the solution, the problem is solved, wouldnt you wonder if they are onto something right?"

    Yes, but it doesn't mean that:

    1. You shouldn't try to find out how to do the working.

    2. That he, his father or grandfather are automatically correct on all mathematical problems.

    Let us not argue on the antiquity of a discipline, but on evidence.

    "Just as modern physics radically improved our understand of the universe and showed that while classical physics is good for day to day uses but yet so incomplete, TCM may prove to be a manifestation of a more precise medicine that our current scientific knowhow cannot yet explain, till a medical "Einstein" comes forth."

    It may, but it may also be similar to the 'ether' theory onced adopted by scientists, which now prove inadequate to explain our understanding of the world.

    The 'it's-true-but-science-can't-explain-it' argument can be used for anything from alternative medicine to the existence of unicorns.

    Let us not argue on evidence we do not have, but on evidence we have.

    By Blogger angry doc, At August 12, 2006 5:17 pm  

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