Angry Doctor

Monday, October 01, 2007

How NOT to argue for Alternative Medicine 8

Another letter supporting TCM using the typical 'cow dung' arguments:

More local hospitals should conduct clinical trials for TCM drugs and treatments

I REFER to the article, 'TCM drug for stroke to undergo clinical trials' (ST, Sept 27).

I support that move and I like to see more local hospitals conduct clinical trials for TCM drugs and treatments.

TCM warrants the serious attention of the medical community. The body of knowledge has survived over thousands of years and is still being practised today. That is testimony to its efficacy and potential.

TCM, however, is a fragmented body where medical prescriptions can be inconsistent, as compared to Western medical treatments.

For example, a cancer patient will be prescribed similar treatment plans if he goes to 10 different oncologists. It could be surgery, radiation therapy, chemotherapy or a combination.

The intensity of therapies and dosages of drugs may differ but the core plan would generally be the same.

If the same cancer patient goes to 10 TCM practitioners, he could get 10 treatment plans; herbal drugs of different kinds, acupuncture of different traditions and even qigong of different schools. It can be confusing and overwhelming.

The evidence-based approach of Western medicine should be applied to TCM. Clinical trials are necessary. Doctors and patients can then have real numbers to work with, in deciding on a treatment plan. There is also a need for a certification body for TCM practitioners, using the protocol of modern medical education. This way, patients can be more confident in TCM physicians. There is also less probability for patients to be swindled by phony physicians.

Western medical treatment can often be too focused and aggressive. The principle is that there is some bad thing in your body so you fall sick. That's why we need to destroy the bad thing. But elimination of the original problem often creates another problem. Chemotherapy is an example where blood cells are destroyed indiscriminately and internal organs are loaded with great stress.

The TCM principle is that an imbalance in the body and a disharmony with the environment make a person sick. The key is to restore balance and harmony.

The treatment may be milder and more holistic. It is also reputed to be useful for palliative care.

Singapore is positioning itself to be a regional medical hub. While we focus on the wave of the future like biomed, let's not neglect the innovations of the past, like TCM.

Felix Ang Kok Hou

Mr Ang sets up a strawman in his criticism of Western medicine - Western medicine is not just about destroying bad things in your body, it is also about homeostasis and 'balance'. Just ask any endocrinologist.

(And anyone who thinks Western medicine is not 'holistic' just needs to do a Geriatric Medicine posting...)

But the difference between Western medicine and TCM is not just one of principles, but also of science and efficacy; chemotherapy for cancer may cause many side-effects to the patient being treated, but it is also better understood and more efficacious than anything TCM has offered.

Mr Ang is correct to say that TCM needs to be studied with an evidence-based approach, but the last three paragraphs of his letter betray a fundamental error in his reasoning: if a mode of therapy traditionally used in TCM is proven to work through clinical trials, it will prove that that mode of therapy works for that condition; it does not, however, prove that the principles behind TCM are true.

As with the case of acupuncture, this type of flawed reasoning is not only unscientific, it also wastes resources which could better go towards improving our understanding of the true mechanisms of action behind TCM therapies.

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  • The TCM principle is that an imbalance in the body and a disharmony with the environment make a person sick.

    Of course we know that if a person is sick there has to be an imbalance in the body and a disharmony with the environment.

    Thus TCM proves itself. QED.


    But Mr. Ang's suggestion is good. If there is evidence of efficacy, the treatment in question will squarely enter the realm of conventional medicine.

    All hail the testable prediction!

    By Blogger Lim Leng Hiong, At October 01, 2007 6:02 pm  

  • I wonder even if TCM treatments are really efficaious, can TCM practioners make accurate diagnoses in the first place?

    Any thoughts on this angrydr?

    By Blogger I must be stupid, At October 01, 2007 9:00 pm  

  • It's all a matter of definition.

    Diagnoses in TCM sometimes do not correspond to diagnoses in Western medicine, but can be something vague like 'weak spleen'.

    Of course the diagnosis of 'weak spleen' can be applied to a number of seperate diagnoses in Western medicine.

    One of the difficulties in conducting trials on TCM is coming to a common case definition and agreeing on a standard intervention for that diagnosis.

    Where they can agree on the above, sometimes efficacy is found. However, in the case of acupuncture it has been found that the site of puncture is not strictly related to the findings, and in the case of herbal medications it is found that it is certain chemical compounds in the herb which gives it its efficacy, and not its ability to influence some unmeasurable 'qi' or 'heatiness'.

    By Blogger angry doc, At October 02, 2007 8:51 am  

  • "weak spleen" is not a diagnosis.

    It is a syndrome differentiation.

    Anyway no point debating lah.

    People believe what they want to believe and are generally biased.


    By Blogger Dr Oz bloke, At October 10, 2007 6:49 pm  

  • mr ang put all his bets on western med and lost the game

    By Anonymous Anonymous, At August 28, 2008 4:57 am  

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