Traditional Chinese Medicine right or wrong?

[MrBird]

I just read this appalling article: http://news.asiaone.com/News/Latest+News/Asia/Story/A1Story20110805-292947.html

And it made me wonder about other widely trusted practices of TCM. I'm all about being respectful to other cultures and being careful not to overstep boundaries (especially when commenting on another physician's work), but I just can't respect doctors who practice traditional Chinese medicine. It just sickens me to read about painful, harmful practices like Gua Sha and Die Da. And it's even more disturbing to learn about how pervasive such beliefs/practices are.

With the spread of modern medicine even to rural parts of China, I don't understand why such practices or even the concept of TCM still exist. Am I being a Western elitist, or should something be done to counteract the prevalence of TCM?

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[ILikeDrugs]

I'm actually intrigued by the actions of the mother bear, if the actions did indeed happen. The simple minded, barbaric humans/parasites, on the other hand, disgust me.

To reply to your question, I believe there are some areas of TCM which are fruitful. I don't think that alternative herbal medicines should be automatically rejected just because it isn't practiced in traditional western medicine. I don't see why herbal medicines are shunned so quickly, when a large percentage of western pharmaceuticals are phytochemical derived, both directly extracted from the plant itself or synthesized. I'm not sure if I'm wording that correctly, but I think I got my point across.

 

[starmia]

That's just one extreme instance of TCM. Many TCM is more about using natural techniques (think: herbs, acupuncture) to heal. The Western or "modern" knowledge of the body is not the most extensive nor is it the only way of seeing our bodies. The Western media really enjoys showing the extremes and I think it can cause so much misperceptions of the East or any other cultures (but that's a whole another problem). In alot of the times, the TCM is the less invasive way to treat illnesses than Western medicine. How is these "harmful" practices using natural remedies that much worse than eating artificial hodgepodge of chemicals called "pills" that Western medicine use to treat pretty much everything?

Oh and to answer your question: TCM is right for some parts and wrong for other parts. It is not absolutely right or wrong and "modern" medicine is not always superior.

 

[tn4596]

That's just one extreme instance of TCM. Many TCM is more about using natural techniques (think: herbs, acupuncture) to heal. The Western or "modern" knowledge of the body is not the most extensive nor is it the only way of seeing our bodies. The Western media really enjoys showing the extremes and I think it can cause so much misperceptions of the East or any other cultures (but that's a whole another problem). In alot of the times, the TCM is the less invasive way to treat lighter illnesses than Western medicine. How is these "harmful" practices using natural remedies that much worse than eating artificial hodgepodge of chemicals called "pills" that Western medicine use to treat pretty much everything?

bear biles, ah i knew about this...this stuff is super expensive. i used to grew up in asia, so many people wanna drink this so they can be strong like a bear lol (actually, the liver is a symbol of courage...how idk go figure, so by consuming the bile, you have the courage of the bear lol) "u are what you eat" in similar manner, people like to eat stuffs like tiger penis, bear's paws, ect...; not because of eastern medicine, no normal "eastern medicine pharmacy" will have these since they are so expensive and it is not like they are a regular medicine used to cure an illness...anyway, the story is touching but it doesnt have anything to do with eastern medicine.

 

[zwitterion34]

Some TCM practitioners actually have an MD degree from China. I asked the opinion of a family physician and he told me even though he doesn't know the exact mechanism of TCM, surprisingly it works sometimes. So he would refer some of his patients to a TCM practitioner if he is unable to treat certain maladies using western medicine. Although there are many qualified individuals practicing TCM, many are sketchy at best. Would you seek a TCM practitioner if you or one of your family members were sick? I wouldn't.

 

[UnclePhil]

2) Understanding that medicine works and TCM does not does not make you a western elitist.

Um.. I hope that you realize there are a lot of scientists in the USA whose research revolves around finding pharmacological effects of natural products used in TCM (or similar practice). Is it that surprising that naturally occurring chemicals may have therapeutic products and that at some point in it's long history, practitioners of Chinese medicine stumbled upon the fact that it had such properties? A lot of chemotherapy drugs are based on scaffolds isolated from natural products and a lot of pharmacy research is based around purifying scaffolds from sources that originate from practices like TCM.

That being said, while this is cruel and inhumane, I have a hard time believing that this is some sort of widespread practice seeing that it made the news in such a dramatic article.

 

[Suncrusher]

Any aspect of TCM that actually works and can be scientifically proven to do so is no longer traditional medicine--it's medicine. Don't partially legitimize all of the horrible and bogus aspects of traditional medicine by leaving the treatments that are actually proven/accepted to work under the banner of traditional medicine. Move those few under the banner of medicine in general.

 

[blizzah]

Some aspects of TCM work. Some don't.

Is there the funding to properly build guidelines and EBM for most of these practices? Nope.

 

[gettheleadout]

1) that's horrifying

Holy crap this.

 

[SBR249]

2) Understanding that medicine works and TCM does not does not make you a western elitist. Scientific truth isn't western, it's universal.

While I'm not a big believer of traditional medicine, I'll just comment that universal scientific truths in no way implies exclusivity. Just as "the sky is blue" does not make "snow is white" false, western medicine's discoveries do not preclude scientific basis in certain aspects of traditional medicine. It's just that much of traditional medicine is empirically derived, unlike much of western science nowadays

I probably also don't need to remind you that there are aspects of western medicine that are also empirically derived. For example, many chemo regimens and drugs are used without knowledge of their mechanisms of action but only their efficacy in clinical trials. Many were also developed through high-throughput chemical screens of both synthetic and naturally-derived compounds in big pharma's chemical libraries. That's not much different from traditional medicines being used because they are good at what they do and discovered by centuries of testing stuff found in the natural environment - except the big pharmas do it much faster.

Any aspect of TCM that actually works and can be scientifically proven to do so is no longer traditional medicine--it's medicine. Don't partially legitimize all of the horrible and bogus aspects of traditional medicine by leaving the treatments that are actually proven/accepted to work under the banner of traditional medicine. Move those few under the banner of medicine in general.

I believe in giving credit where it's due. If a traditional remedy has scientific basis or efficacy, then I will still call it traditional medicine because it was developed through traditional empirical observations using traditional methods and probably passed down through tradition.

 

[Gigantron]

I've heard of this thing called a placebo back when I was fow (4). I hear it works wonders.

 

[isoquin]

I find the article to be a bit overdramatic, as it anthropomorphizes the momma bear hugging the baby bear before killing it. I can't help but wonder about the legitimacy of this story, while acknowledging such a practice seems barbaric.

Modern science and medicine is not above finding helpful cures from natural remedies. Aspirin is a perfect example that permeates this society. But as someone else said, any alternative medicine that has been proven to work is better known simply as "medicine." Alternative treatments work in varying degrees much like the placebo effect does. The best advice I can give you in counseling your patients is to tell them "if (insert random herb) works for you, and we know it isn't doing anything bad, go for it." Chances are they were just looking for someone to agree with them. Short of negative side effects, neutrality works well.

 

[nysw]

On another thread I frequent, some of the comments were like, "omg that's so gross, I can't believe they're eating bear poop!" smh.

There's a lot of research being done on TCM & other homeopathic remedies to see if there's any sort of basis. Sometimes it's the placebo effect, but it's hard to research/dismiss something when it's hard to investigate - too hard to extract, lots of different chemicals/compounds involved. Until there's good solid research saying that it absolutely does not work, I don't think it's appropriate to start 'counteracting the prevalence of TCM'. After all, the Chinese have used these remedies for seriously, thousands of years. Gotta be good for something.

 

[MrBird]

But the layperson doesn't understand the concept that just because some TCM treatments are effective doesn't mean all of TCM is legitimate. I know of some people who have recovered from illnesses after taking traditional chinese herbal medicine and have since relied solely on TCM treatment for all their ailments to, I believe, the detriment of their health.
Isn't it in favor of public health in general to enforce a disclaimer on TCM products, treatments?

 

[MrBird]

http://www.youtube.com/watch?v=-4FFmGPPW3w

"Dr. Zhang's differnet modalities treatment.
Gua sha (scraping) move blood, reduce heat, boost body immunity, increase capillary circulation."

^Yea, try to tell me that isn't bs treatment. It's used all the time in East Asian health facilities. I've actually seen it done in a Chinese clinic in Manhattan's Chinatown. Brutal.

 

[drizzt3117]

Chinese medicine has been around for a long time and has been shown to work in many cases. What we need to get rid of is stuff like this.

http://lasemedinc.com/

This site would have made me laugh with its laser sounds over the left sidebar and music if one pt I saw hadn't undergone 2 weeks of "laser therapy" for her treatable breast cancer and came back to the real Hosp a few years later after it ulcerated out of her skin and she had mets everywhere.

1) Why do we need to disprove the effectiveness of every one of TCMs thousands of asanine herbal combinations before we can take it off the market, but we need to prove the effectiveness of every medical drug in a three stage, double blind trial before we're allowed to sell them? Why are our drugs guilty until proven innocent but the bear torture bile pill gets a pass until someone chooses to fund a definitive bear torture bile study?

2) Why is something being really, really old tradition a sign that it works? Isn't that a pretty good argument for miracle healing and protective crystals as well? For that matter, isn't that a pretty good argument for dictatorships, torture, and women being the rightful property of men? I mean those are ancient traditions, while liberation and human rights are pretty modern concepts. Try and imagine the thunder fearing asian savage who made the rules up for TCM, all those thousands of years ago. Ask yourself, if you met him on the street today, and he said he had miracle cure for you, would you swallow it? If not, why does his being thousands of years dead suddenly make his cure a good idea?

3) All that aside, shouldn't the theory of something that we do at least make sense before we do it? Is the liver really the 'seat of courage'? Is there really a 'life energy' flowing around your body that can be corrected with chemical compounds? If you're trying to fix a part that's not actually there, isn't that a pretty good sign that you're not going to succeed in fixing anything?

 

[Epen]

Anyone here ever read "Trick or Treatment"? This book gave evaluations of the scientific evidence for and against alternative therapies. Although the only traditionally far-eastern method reviewed was acupuncture, it raised a good and universally relevant point for all forms of alternative treatment, TCM or no:

More often than not, people will go to alternative therapies, which have been tentatively proven to work for some ailments, for problems which are not helped by those therapies. The problem comes from when practitioners actively deny the studies disproving their craft. The primary example was in acupuncture: although some studies suggest it may work for back pain, practitioners will not refuse to treat you for diabetes, infertility, etc.

So, as other posters have mentioned, the first step is to find the science behind the results (or non-results) of alternative medicines. But the second, more important, step is to find a way to stop practitioners from offering those specific services which have been shown not to work and to stop patients from believing the hokum therein.

THEN we can liberate the melodramatic momma bears.

 

[MrBird]

1) why do we need to disprove the effectiveness of every one of tcms thousands of asanine herbal combinations before we can take it off the market, but we need to prove the effectiveness of every medical drug in a three stage, double blind trial before we're allowed to sell them? Why are our drugs guilty until proven innocent but the bear torture bile pill gets a pass until someone chooses to fund a definitive bear torture bile study?

2) why is something being really, really old tradition a sign that it works? Isn't that a pretty good argument for miracle healing and protective crystals as well? For that matter, isn't that a pretty good argument for dictatorships, torture, and women being the rightful property of men? I mean those are ancient traditions, while liberation and human rights are pretty modern concepts. Try and imagine the thunder fearing asian savage who made the rules up for tcm, all those thousands of years ago. Ask yourself, if you met him on the street today, and he said he had miracle cure for you, would you swallow it? If not, why does his being thousands of years dead suddenly make his cure a good idea?

3) all that aside, shouldn't the theory of something that we do at least make sense before we do it? Is the liver really the 'seat of courage'? Is there really a 'life energy' flowing around your body that can be corrected with chemical compounds? If you're trying to fix a part that's not actually there, isn't that a pretty good sign that you're not going to succeed in fixing anything?

boo yah

 

[FattySlug]

http://www.youtube.com/watch?v=-4FFmGPPW3w

"Dr. Zhang's differnet modalities treatment.
Gua sha (scraping) move blood, reduce heat, boost body immunity, increase capillary circulation."

^Yea, try to tell me that isn't bs treatment. It's used all the time in East Asian health facilities. I've actually seen it done in a Chinese clinic in Manhattan's Chinatown. Brutal.

That actually works. I have tried it myself and many others have. I guess trying to tell you that is meaningless since you already make up your mind to call it B.S. sure the way they explain why it works might sound funny but it really does work. End of story.

Of course ridic. practices and ones that involve animal cruelty need to be stopped but can't deny the fact that many many treatments of TCM have been working for thousands of years.

 

[MrBird]

That actually works. I have tried it myself and many others have. I guess trying to tell you that is meaningless since you already make up your mind to call it B.S. sure the way they explain why it works might sound funny but it really does work. End of story.

Of course ridic. practices and ones that involve animal cruelty need to be stopped but can't deny the fact that many many treatments of TCM have been working for thousands of years.

You wanna tell me how it "gets rid of fever" or "cures cholera?"
The basis of the practice is apparently in the "releasing of channel blockages in different appendages." If you believe in that practice, you inherently have to believe in the existence of meridians and qi regulating. http://en.wikipedia.org/wiki/Traditional_Chinese_medicine

If that's the case, I don't know what to say to you.

 

[FattySlug]

You wanna tell me how it "gets rid of fever" or "cures cholera?"
The basis of the practice is apparently in the "releasing of channel blockages in different appendages." If you believe in that practice, you inherently have to believe in the existence of meridians and qi regulating. http://en.wikipedia.org/wiki/Traditional_Chinese_medicine

If that's the case, I don't know what to say to you.

Never had cholera so not gonna say anything about that but it does cure fever. I am not saying I believe in anything stop using that dumb logic. I am here to provide a data point that it has cured fever really really fast and also very effective in curing asthma. My uncle has a severe case of asthma and Chinese medicine that he tried suppresses it wonderfully.

Edit: His attacks are so few and far in between that sometimes he forgets he has them.

 

[MrBird]

Never had cholera so not gonna say anything about that but it does cure fever. I am not saying I believe in anything stop using that dumb logic. I am here to provide a data point that it has cured fever really really fast and also very effective in curing asthma. My uncle has a severe case of asthma and Chinese medicine that he tried suppresses it wonderfully.

Edit: His attacks are so few and far in between that sometimes he forgets he has them.

Fair enough. It's not hard for me to believe there are some chemical compounds in certain Chinese herbs that are conceivably useful for treating SOME illnesses, but what alarms me is that a lot of people (literally hundreds of millions) believe that because some aspects of TCM are beneficial, all of its practices must be legitimate, and the practitioners of TCM won't argue otherwise.

Case in point, the "Congress of Traditional Chinese Medicine" has started its own medical journal, and I'll let you read the laughably bad science in a research experiment about acupuncture: http://www.cmjournal.org/content/6/1/2

 

[FattySlug]

Fair enough. It's not hard for me to believe there are some chemical compounds in certain Chinese herbs that are conceivably useful for treating SOME illnesses, but what alarms me is that a lot of people (literally hundreds of millions) believe that because some aspects of TCM are beneficial, all of its practices must be legitimate, and the practitioners of TCM won't argue otherwise.

Case in point, the "Congress of Traditional Chinese Medicine" has started its own medical journal, and I'll let you read the laughably bad science in a research experiment about acupuncture: http://www.cmjournal.org/content/6/1/2

Of course I agree that there are aspects of TCM that are flat out stupid but I heard you condemning Gua Sha as b.s. and just want to provide some different perspectives since I am someone who has used it before.

 

[FattySlug]

Everything works, some of the time. Or rather, some of the time everyone gets better regardless of the treatment they're recieving. That's why we have to have controls in clinical trials, because we need to show not only that people are getting better from the therapy that they're getting but that MORE of them are getting better than the people who recieve the fake therapy. Because some people get better from anything.

Quackary sells because they treat everyone who has, or imagines they have, anything at all. Some people get better naturally and quackary clams the credit. Some people think they're getting better because they're in treatment and quackary claims the credit. Some people get worse but the quack convinces them they're not as bad as they WOULD be without the quacks help and quackary claims the credit. Finally a good chunk of people realize they're paying a lot for nothing and walk away, but honestly that's not enough to seriously impact the quacks cutomer base since he now has a good number of loyal customers who now are 'living proof' that his nonsense works. Physicians used to do the same thing. Then they made the FDA and now its illeagal.

You're a young man who had fever that resolved. Your uncle has mild persistent asthma that he often forgets about that he thinks improved. This are both normal spontaneous outcomes that any primary care physician would shrug his/her shoulders at. Do you see how this isn't really proof that CAM/TCM sense?

It's not proof of CAM/TCM as a whole, definitely. My fever is cured after one session is a weak example but my uncle's asthma was really bad and did not improve significantly after use of western medicine so he turned to TCM instead and it works for him. I am not trying to prove anything just to say from my experiences it is at least very effective on fever and asthma. You can call it whatever you want.

 

[nysw]

1) Why do we need to disprove the effectiveness of every one of TCMs thousands of asinine* herbal combinations before we can take it off the market, but we need to prove the effectiveness of every medical drug in a three stage, double blind trial before we're allowed to sell them? Why are our drugs guilty until proven innocent but the bear torture bile pill gets a pass until someone chooses to fund a definitive bear torture bile study?

Just fyi, TCM is a field of its own study and requires certification to practice in the US and China. They're not FDA approved. It's like people taking melatonin for sleep problems or bilboa gingko for memory enhancement. Who gives a damn, it's not doing anything to the people. Also, 'our' drugs are guilty until proven innocent because they haven't been empirically tested. The bear torture is unfortunate, but a lot of people now take the synthetic bile capsules. I think the only part of this we need to nix is bear torture. I think why bear bile works for a lot of people is because it's higher in ursodeoxycholic acid than human bile. An increase in urso has a lot of health benefits for humans. It's not completely bunk.

2) Why is something being really, really old tradition a sign that it works? Isn't that a pretty good argument for miracle healing and protective crystals as well? For that matter, isn't that a pretty good argument for dictatorships, torture, and women being the rightful property of men? I mean those are ancient traditions, while liberation and human rights are pretty modern concepts. Try and imagine the thunder fearing asian savage who made the rules up for TCM, all those thousands of years ago. Ask yourself, if you met him on the street today, and he said he had miracle cure for you, would you swallow it? If not, why does his being thousands of years dead suddenly make his cure a good idea?

Not even worth addressing. It's like questioning empirically proven medical methods. It works for people. Simple. Also, what the hell, I knew you were going to bring that up. Most of the TCM that's still used today doesn't hurt people - dictatorships, torture, and misogyny do.
Also, 'Asian savage'? 'made up the rules for TCM'? Absolutely reeks of Western elitism.

3) All that aside, shouldn't the theory of something that we do at least make sense before we do it? Is the liver really the 'seat of courage'? Is there really a 'life energy' flowing around your body that can be corrected with chemical compounds? If you're trying to fix a part that's not actually there, isn't that a pretty good sign that you're not going to succeed in fixing anything?

Learn some history first. Before modern Western medicine, most people in Europe subscribed to something called the Hippocratic theory of humors. Balancing the four humors was the focus of most Western medicine from the time of the Greeks all the way until the 19th century.
TCM focuses on balancing the yin and yang, which is similar to this theory. It's really complex and can't just be boiled down to 'life energy'.

boo yah

Mature.

 

[gettheleadout]

Learn some history first. Before modern Western medicine, most people in Europe subscribed to something called the Hippocratic theory of humors. Balancing the four humors was the focus of most Western medicine from the time of the Greeks all the way until the 19th century.
TCM focuses on balancing the yin and yang, which is similar to this theory. It's really complex and can't just be boiled down to 'life energy'.

Who cares? Just as we now know disease isn't based on balancing the four humors, we also know it isn't based on anything like yin and yang either.

 

[drizzt3117]

What do you recommend for the elderly patient with incurable metastatic cancer? (given the population we'll say HCC with venous extension or small cell lung cancer). Statistically speaking, TCM has as much chance of cure and/or extending life than any conventional treatment and I bet in elderly Chinese, they'd have higher quality of life with TCM over "modern" therapies.

Who is paying for all these large-scale clinical trials you're advocating? Drug companies... See where I'm going with this? This is not a cut/dried issue. There's a lot of very bad science everywhere, not surprising given the amount of money at stake.

Everything works, some of the time. Or rather, some of the time everyone gets better regardless of the treatment they're recieving. That's why we have to have controls in clinical trials, because we need to show not only that people are getting better from the therapy that they're getting but that MORE of them are getting better than the people who recieve the fake therapy. Because some people get better from anything.

Quackary sells because they treat everyone who has, or imagines they have, anything at all. Some people get better naturally and quackary clams the credit. Some people think they're getting better because they're in treatment and quackary claims the credit. Some people get worse but the quack convinces them they're not as bad as they WOULD be without the quacks help and quackary claims the credit. Finally a good chunk of people realize they're paying a lot for nothing and walk away, but honestly that's not enough to seriously impact the quacks cutomer base since he now has a good number of loyal customers who now are 'living proof' that his nonsense works, and a lot of those people are customers for life since quacks never actually cure anyone. Physicians used to do the same thing. Then they made the FDA and now its illeagal.

You're a young man who had fever that resolved. Your uncle has mild persistent asthma that he often forgets about that he thinks improved. This are both normal spontaneous outcomes that any primary care physician would shrug his/her shoulders at. Do you see how this isn't really proof that CAM/TCM sense?

 

[FIREitUP]

Never had cholera so not gonna say anything about that but it does cure fever. I am not saying I believe in anything stop using that dumb logic. I am here to provide a data point that it has cured fever really really fast and also very effective in curing asthma. My uncle has a severe case of asthma and Chinese medicine that he tried suppresses it wonderfully.

Edit: His attacks are so few and far in between that sometimes he forgets he has them.

fever is not a disease; you can't cure it. it's a symptom.

 

[DeadlyWarbler]

I'm coming in a bit late on this, but thought I should chime in since I am a pre-med as well as a trained acupuncturist. TCM is actually remarkable because some of the practices have remained unchanged in some cases for thousands of years. Refer to the Oetzi Ice Man who was dated at over 5000 years old. X-rays of his skeleton determined that he suffered from arthritis in his SI joint and lumbar. Tatoos found on his preserved skin coincide exactly with acupuncture points that modern acupuncturists would use to treat that very condition. However, modern TCM is far different from the material portrayed in this article. Bear gallbladders, tiger bones, these are antiquities of TCM that have no relevance in the modern world. As a practitioner of the medicine, I hardly consider this part of the medicine any longer. Western medicine has a few dings in it's history as well (think: blood letting). If you want to get a sense for modern TCM, have a look at the 1997 NIH consensus on acupuncture. This document is available online.

As for the credibility of TCM practitioners, we all are required to complete a four-year program and pass state and national licensing exams. It is no longer legal to be "grandfathered" in. The first two years of training are in Chinese medicine and Western medical sciences. These include biology, chemistry, physics, organic chemistry, pathophysiology and immunology. We were trained by allopathic physicians in pathophysiology, pharmacology (as well as herb-drug interactions), emergencies and red flags and western case management. The last two years are both didactic and clinical as we are required to complete a two year internship while taking elective courses to outline our specialty. We are held in many states as primary care providers, though this fact is contentious for good reason because we aren't trained to do screenings and disease prevention thought modern means (colonoscopies, etc.) However, all acupuncturist are trained on when it is appropriate to refer out. I will admit that few acupuncturist are created equal, which lends to some inconsistencies in care. However, anyone carrying the title L.Ac., Dipl.OM or DAOM is well qualified to handle almost any patient.

I am working to get into medical school to gain a better understanding of medicine and broaden my ability to see as many people as possible. Many of you pre-meds will do well to do the same because the ultimate goal is not what is right or wrong, it's what is right or wrong for the patient you are seeing.

 

[zwitterion34]

Can you say the same thing about chiropractic? http://en.wikipedia.org/wiki/Chiropractic

For me, as I mentioned earlier, I would not seek any form of alternative medicine because of our lack of research regarding these and our lack of understanding why these treatments work. But the decision lies on the individual.

 

[zwitterion34]

What I would recommend is hospice care. If you read my posts you know that I rant a lot about Medicine, and that I don't think particularly highly of our claims to selflessness and nobility. However there is one thing that medicine does that is, truely, difficult, selfless, and noble: we admit when we're powerless. When a patient has a terminal disease that there is no therapy for we, though it is heart breaking, admit that we have nothing to offer them. Though such patients are usually willing, often begging, for the opportunity to throw their life savings at any hope we might offer we decline to rob them. Though we have the opportunity to pretend we're superheros for a little bit longer, we instead admit that we are as powerless as they are.

It's a good thing. It gives the patient a real shot of grieving, and reconciling with those around him, before the end. It's also, ultimately, why patients know that when we say we have a therapy that does work that we can be trusted. But it's hard. It would be much easier to do what CAM does, and offer them daily expensive treatments and the vague hope of an impossible recovery for as long as they have the money to spend and the strength to get out of bed. But that would be wrong.

I completely agree with you.

 

[drizzt3117]

Given that there hasn't been any clinical trials of patient quality of life between CAM/TCM in end stage malignancy to my knowledge, I don't think this statement is backed by EBM either. One thing about the placebo effect is that the efficacy is based on the patient's belief that they're getting an effective treatment (I.e. You're not telling them they're getting a sugar pill). Hope is a powerful tool. If you've ever managed ICU patients, then you probably know That we know very little about why some patients die why others turn the corner, even though they have similar clinical courses.

We don't know anywhere near enough about disease pathophysiology to be making blanket statements about what works and what doesn't.

Furthermore, even if one did want to make a clinical trial testing TCM vs conventional treatment, it's unlikely (at best) that such a trial would be funded. Think big pharma would pay for it?

What I would recommend is hospice care. If you read my posts you know that I rant a lot about Medicine, and that I don't think particularly highly of our claims to selflessness and nobility. However there is one thing that medicine does that is truely difficult, selfless, and noble: we admit when we're powerless. When a patient has a terminal disease that there is no therapy for we, though it is heart breaking, admit that we have nothing to offer them. Though such patients are usually willing, often begging, for the opportunity to throw their life savings at any hope we might offer we decline to rob them. Though we have the opportunity to pretend we're superheros for a little bit longer, we instead admit that we are as helpless as they are.

It's a good thing. It gives the patient a real shot of grieving, and reconciling with those around him, before the end. It's also, ultimately, why patients know that when we say we have a therapy that does work that we can be trusted. But it's hard. It would be much easier to do what CAM does, and offer them daily expensive treatments and the vague hope of an impossible recovery for as long as they have the money to spend and the strength to get out of bed. But that would be wrong.

 

[10Acious]

You do know that Gua Sha is COMPLETELY painless right? I've had it done.

 

[ALMD]

http://www.youtube.com/watch?v=-4FFmGPPW3w

"Dr. Zhang's differnet modalities treatment.
Gua sha (scraping) move blood, reduce heat, boost body immunity, increase capillary circulation."

^Yea, try to tell me that isn't bs treatment. It's used all the time in East Asian health facilities. I've actually seen it done in a Chinese clinic in Manhattan's Chinatown. Brutal.

I had it done on me before. It didn't hurt me, felt pretty good afterward actually

 

[ALMD]

You do know that Gua Sha is COMPLETELY painless right? I've had it done.

Agree, it looks like it hurts bad but it doesn't.

 

[ponyo]

Um.. I hope that you realize there are a lot of scientists in the USA whose research revolves around finding pharmacological effects of natural products used in TCM (or similar practice). Is it that surprising that naturally occurring chemicals may have therapeutic products and that at some point in it's long history, practitioners of Chinese medicine stumbled upon the fact that it had such properties? A lot of chemotherapy drugs are based on scaffolds isolated from natural products and a lot of pharmacy research is based around purifying scaffolds from sources that originate from practices like TCM.

My mother, who's now a neuroscientist, got her Ph.D. in pharmaceutics from a major Japanese university. Her thesis was the isolation of an anti-cancer compound from a natural remedy that had been in use for thousands of years. In Japan and China (not sure about Korea) there are actually a lot of scientists who basically take TCM remedies, test them on animal models to see if they work, and then isolate the active chemical ingredient to figure out the biochemical mechanism for the original remedy. My feeling is that if a TCM drug works really well on a rat with, say, hepatic cancer (what my mother worked with), you probably can't chalk it up to placebo effect.

I probably also don't need to remind you that there are aspects of western medicine that are also empirically derived. For example, many chemo regimens and drugs are used without knowledge of their mechanisms of action but only their efficacy in clinical trials. Many were also developed through high-throughput chemical screens of both synthetic and naturally-derived compounds in big pharma's chemical libraries. That's not much different from traditional medicines being used because they are good at what they do and discovered by centuries of testing stuff found in the natural environment - except the big pharmas do it much faster.

I believe in giving credit where it's due. If a traditional remedy has scientific basis or efficacy, then I will still call it traditional medicine because it was developed through traditional empirical observations using traditional methods and probably passed down through tradition.

But the layperson doesn't understand the concept that just because some TCM treatments are effective doesn't mean all of TCM is legitimate. I know of some people who have recovered from illnesses after taking traditional chinese herbal medicine and have since relied solely on TCM treatment for all their ailments to, I believe, the detriment of their health.

I'm pretty sure this would be attributed to the extreme gullibility of the individual, esp. since Chinese people in CHINA don't even rely solely on TCM... Everybody goes to western medicine for actual diseases. TCM is really mainly used for chronic, ideopathic ailments that western medicine can't really do anything for, so like chronic fatigue, back pain, dysmenorrhea, migraines etc. Nobody would take a kid with pneumonia or appendicitis or something to a TCM practitioner.

Finally, yes, a lot of TCM is BS... I think this is less about TCM itself and more about the total lack of academic honesty in China. People just don't care about the scientific method and that's a real problem.

 

[MrBird]

Finally, yes, a lot of TCM is BS... I think this is less about TCM itself and more about the total lack of academic honesty in China. People just don't care about the scientific method and that's a real problem.

 

[SBR249]

Finally, yes, a lot of TCM is BS... I think this is less about TCM itself and more about the total lack of academic honesty in China. People just don't care about the scientific method and that's a real problem.

It's not about give a crap about scientific method and stuff. It's economics. Quality (read: non-counterfeit) western drugs cost $$$$$ which an average chinese person is not going to be able to afford (at least not at the current 6.4:1 RMB to USD exchange rates). Chinese medicines are out of the question (given the amount of counterfeit crap flooding the market, you are better off not taking anything). So that leaves TCM which is cheap, possibly effective, a lot of placebo effect, and you at least can sort of identify what the hell you are taking (I've seen those herbal packets and I've also taken them before so this is personal experience).

So yeah....my $0.02 as someone who has had up close and sometimes stomach-turning experience with TCM and who grew up in China.

 

[isoquin]

I don't think it's appropriate to start 'counteracting the prevalence of TCM'. After all, the Chinese have used these remedies for seriously, thousands of years. Gotta be good for something.

People have also been building outhouses next to their drinking water for thousands of years, that reasoning is not how good public health works.

What was the average lifespan of someone in China thousands of years ago? Compare to today. Now back to feudal ages, and think about today once more. Do you see the difference? Can you actually attribute longer healthier lives to the stuff which has gone unchanged for thousands of years?

My uncle has a severe case of asthma and Chinese medicine that he tried suppresses it wonderfully.

This is called anecdotal evidence. It is the (usually) incorrect generalization of an unrepresentative sample. This is precisely the reason we have loons screaming about vaccines causing autism.

Modern medicine does not prescribe based on a drug working for ONE person, nor does it prescribe based on the percentage of people "cured" by the placebo effect.

 

[FattySlug]

This is called anecdotal evidence. It is the (usually) incorrect generalization of an unrepresentative sample. This is precisely the reason we have loons screaming about vaccines causing autism.

Modern medicine does not prescribe based on a drug working for ONE person, nor does it prescribe based on the percentage of people "cured" by the placebo effect.

Agreed. But it also works for other people as well. How big is the sample size I would not know but that is my personal experience and not meant to use to validate TCM as a whole but only the portion that works for me and others that I have seen with my own eyes. I provided my exp because I saw a certain level of ignorance in this thread like OP claiming gua sha being painful and then "losing respect" for TCM practitioner. I guess this is why medical schools want a diverse student body.

If there is institution that formally trains TCM practitioner (don't know if there is any, haven't looked into it) and teaching weird/harmful practices then you can question TCM credibility but the sources I saw in this thread are more like quacks using TCM as a cover to make money and to use that to condemn TCM as a whole is not a thing anyone would do. Such unethical practices are pervasive because they target the poor and uneducated population. I grew up in a working class neighborhood in Vietnam right after the war so I know that western medicine was expensive at that time so people turned to TCM.

I am sure in some remote corners of the world there is a quack out there using western medicine as a cover too and nobody would use him to condemn western medicine.

 

[isoquin]

Again, you are using anecdotal, and even unsupported theoretical evidence. By saying there might be someone in the world using standardized "western" medicine inappropriately is once again prescribing an unrepresentative sample to a generalization.

There is no standardization for alternative medical practices, which means the outcomes have significantly larger variability compared to US trained doctors.

You will always be correct in saying "but [insert anything here] works for some people." Unless a medical practice reliably works for a targeted population, it really ought not be prescribed to the masses as medicine, else we are simply using the placebo effect to treat people. Seen from the other side, if someone is already on a placebo and gaining some benefit from it, doctors should generally use the line "if it works for you and it's not causing any harm, keep using it."

 

[FattySlug]

Again, you are using anecdotal, and even unsupported theoretical evidence. By saying there might be someone in the world using standardized "western" medicine inappropriately is once again prescribing an unrepresentative sample to a generalization.

I am too lazy to dig up history but you know that there have been people using western medicine inappropriately before. I don't think that is theoretical at all. I only used that argument to say that it is unfair to disregard TCM as a whole based on a few quacks who use TCM as a cover.

The U.S. can ban TCM if it likes. I really don't care. TCM is mostly the last ditch efforts from patients to get better where western medicine tell them there is no chance. Is TCM valid? Not everything. Should we ban it? Not up for me to decide. What am I here for? ONLY to give a different perspective on things.

 

[Musclemass]

It's not about give a crap about scientific method and stuff. It's economics. Quality (read: non-counterfeit) western drugs cost $$$$$ which an average chinese person is not going to be able to afford (at least not at the current 6.4:1 RMB to USD exchange rates). Chinese medicines are out of the question (given the amount of counterfeit crap flooding the market, you are better off not taking anything). So that leaves TCM which is cheap, possibly effective, a lot of placebo effect, and you at least can sort of identify what the hell you are taking (I've seen those herbal packets and I've also taken them before so this is personal experience).

What you're describing is a problem IN CHINA that IT needs to deal with. We're here, not there.

My view is that procedures and modalities that aren't backed by solid science (and those who practice same) shouldn't be allowed or tolerated. Whether the "treatment" is traditional, chiropractic, homeopathic, or whatever, doesn't matter to me. The damage is done by gullible people falsely believing in the efficacy of the unsupported "alternative" approach instead of getting proper care.

I know from personal experience that many of these alternative practitioners don't personally believe their own BS, it's just a way to make money. They're all careful about what they say and how they say it.

 

[ponyo]

It's not about give a crap about scientific method and stuff. It's economics. Quality (read: non-counterfeit) western drugs cost $$$$$ which an average chinese person is not going to be able to afford (at least not at the current 6.4:1 RMB to USD exchange rates). Chinese medicines are out of the question (given the amount of counterfeit crap flooding the market, you are better off not taking anything). So that leaves TCM which is cheap, possibly effective, a lot of placebo effect, and you at least can sort of identify what the hell you are taking (I've seen those herbal packets and I've also taken them before so this is personal experience).

So yeah....my $0.02 as someone who has had up close and sometimes stomach-turning experience with TCM and who grew up in China.

I grew up in China too and have had a ton of first-hand experiences with the Chinese pharmaceutical industry. You know those legendary dinners where lobbyists and corrupted government officials talk about their mistresses, get wasted over $5k meals of sea cucumber and shark fins and bear claw, and sign wondrously profitable yet horribly wrong deals? I've been to more than my fair share of those. It's actually a real struggle to keep from throwing up in your mouth.

If you grew up in China, I'm sure you're more than familiar with the fact that Chinese people just do not give a crap about things like cheating, faking data, bribes etc. A lot of scientists are honest and try not to do that, but the general atmosphere rewards that kind of thing. I won't name specific universities, but giving PIs cash incentives for every paper published depending on the tier of the journal is just not a good way to ensure quality data, ESPECIALLY in TCM, where it's really unlikely that other people will care about replicability.

And it's not just because TCM in general is cheaper. If that were the case, we wouldn't have the 200 generations of hybrid medications for cold/flu that came out over the last 2 decades. You would expect, at least for simple illnesses, that people would stick with what they always used because it was cheap and it worked. But we don't do this. Remember in the 90s, when it was actually acceptable to give people acetaminophen--pu re xi tong? If a doctor tried to give a patient that now, the patient would bite his head off for "not trying hard enough", because of all the idiotic marketing for the brand-name drgs that cost like 50k yuan to develop but are marked up more than 20x to the patient.

It's not because Chinese people are poor. It's because pharma is profitable, everywhere, and far more profitable if you can get away with as little R&D as possible before your new awesome untested expensive drug can hit the market. And even poor people are great customers when they think their lives are on the line.

It makes me depressed as hell that the most important and relevant part of TCM--empirical pharmacology as a source for pharmaceutically active compounds--is being researched in Japan way more reliably and fruitfully than it is in China, but if we don't get our **** together and change the atmosphere of Chinese R&D, that's not going to change. I think it's great that our economy is expanding and when I go home, there aren't people dying in front of my house anymore, but it is just not sustainable to keep teaching our students that it's totally cool to cut corners in every aspect of life and bribe your way into getting whatever you want.

Oh lastly, on those herbal packets... I have relatives who make those and a lot of them are laced with crap like opiates. They basically use the same recipe as Tong Ren Tang (major TCM producer), with a little kick so that it makes you feel EXTRA good. And I have seen these in NYC... they have ying su shell as a major ingredient. I don't even buy Chinese medicine in America, because most of them are fake or have really interesting components... I buy them from family friends in pharma who know which ones are actually clinically tested (which are, by far, in the minority).

/rant before I miss dinner hour

 

[45408]

Um.. I hope that you realize there are a lot of scientists in the USA whose research revolves around finding pharmacological effects of natural products used in TCM (or similar practice). Is it that surprising that naturally occurring chemicals may have therapeutic products and that at some point in it's long history, practitioners of Chinese medicine stumbled upon the fact that it had such properties? A lot of chemotherapy drugs are based on scaffolds isolated from natural products and a lot of pharmacy research is based around purifying scaffolds from sources that originate from practices like TCM.

Even a broken clock is right twice a day. It would be hard for all of alternative medicine to be wrong all of the time, so they're usually just wrong most of the time. If you drink enough homeopathic medications, you'll cure mild dehydration.

 

[AZFutureDoc]

Threads like these show me how little I know about so many important topics. I don't even know where to start looking for solid, accessible info on this kind of stuff for interview preparation.

 

[SBR249]

What you're describing is a problem IN CHINA that IT needs to deal with. We're here, not there.

I'd venture to say that a significant portion of TCM users in the US are 1st gen chinese immigrants or expats. If you want to deal with that problem here, you should try to solve it at the root.

Also, I was replying to this quote by ponyo, which is clearly referring to a problem IN CHINA:

Finally, yes, a lot of TCM is BS... I think this is less about TCM itself and more about the total lack of academic honesty in China. People just don't care about the scientific method and that's a real problem.

 

[SBR249]

I grew up in China too and have had a ton of first-hand experiences with the Chinese pharmaceutical industry. You know those legendary dinners where lobbyists and corrupted government officials talk about their mistresses, get wasted over $5k meals of sea cucumber and shark fins and bear claw, and sign wondrously profitable yet horribly wrong deals? I've been to more than my fair share of those. It's actually a real struggle to keep from throwing up in your mouth.

If you grew up in China, I'm sure you're more than familiar with the fact that Chinese people just do not give a crap about things like cheating, faking data, bribes etc. A lot of scientists are honest and try not to do that, but the general atmosphere rewards that kind of thing. I won't name specific universities, but giving PIs cash incentives for every paper published depending on the tier of the journal is just not a good way to ensure quality data, ESPECIALLY in TCM, where it's really unlikely that other people will care about replicability.

And it's not just because TCM in general is cheaper. If that were the case, we wouldn't have the 200 generations of hybrid medications for cold/flu that came out over the last 2 decades. You would expect, at least for simple illnesses, that people would stick with what they always used because it was cheap and it worked. But we don't do this. Remember in the 90s, when it was actually acceptable to give people acetaminophen--pu re xi tong? If a doctor tried to give a patient that now, the patient would bite his head off for "not trying hard enough", because of all the idiotic marketing for the brand-name drgs that cost like 50k yuan to develop but are marked up more than 20x to the patient.

It's not because Chinese people are poor. It's because pharma is profitable, everywhere, and far more profitable if you can get away with as little R&D as possible before your new awesome untested expensive drug can hit the market. And even poor people are great customers when they think their lives are on the line.

It makes me depressed as hell that the most important and relevant part of TCM--empirical pharmacology as a source for pharmaceutically active compounds--is being researched in Japan way more reliably and fruitfully than it is in China, but if we don't get our **** together and change the atmosphere of Chinese R&D, that's not going to change. I think it's great that our economy is expanding and when I go home, there aren't people dying in front of my house anymore, but it is just not sustainable to keep teaching our students that it's totally cool to cut corners in every aspect of life and bribe your way into getting whatever you want.

Oh lastly, on those herbal packets... I have relatives who make those and a lot of them are laced with crap like opiates. They basically use the same recipe as Tong Ren Tang (major TCM producer), with a little kick so that it makes you feel EXTRA good. And I have seen these in NYC... they have ying su shell as a major ingredient. I don't even buy Chinese medicine in America, because most of them are fake or have really interesting components... I buy them from family friends in pharma who know which ones are actually clinically tested (which are, by far, in the minority).

/rant before I miss dinner hour

tl;dr, but your point doesn't address why Chinese people continue to use TCM if big pharma is so effectively marketing their marked up hybrid or western medications. I'm saying that TCM is still so prevalent, especially among the older generation in China, because it's cheap and it's not an unknown gamble like Chinese-made meds and won't bankrupt you like genuine western-made meds. It's certainly not because your typical high-school educated housewife pulled out a scientific journal and read a paper on non-reproducible data showing how effective TCM is.

Granted I left China more than 10 years ago so I'm not as up on the status quo, but back in the 90s the difference between herbal TCM packets and western medicines can be at least several fold or more in price. As for lacing them with opiates, I can tell you for sure that wasn't done back then, idk about now.

 

[45408]

Threads like these show me how little I know about so many important topics. I don't even know where to start looking for solid, accessible info on this kind of stuff for interview preparation.

http://www.sciencebasedmedicine.org/

 

[SBR249]

People really, really want the CAM therapies to work. Real medicine is decidedly not sexy anymore; NNT, statistics, biochemical mechanisms. They are hard to understand, there is nothing "certain" about them, and they feel inaccessible to your average American who doesn't really understand any of it.

CAM on the other hand, feels spiritual and mystical. Thousands of years of tradition can't be wrong, right? Of course, we all know that it can be, and often is, which is why we don't "bleed" patients any more, we don't cut off the clitoris of young girls anymore, and we don't perform frontal lobotomies for hysteria any more.

The fact that a few items in their "pharmacy" have medicinal properties when properly purified is nothing exciting. Scientists have been isolating natural compounds for medical use for centuries. The whole distinction between "natural" and "chemical" or "artificial" or "lab-based" is one big load of bullcrap.

Insisting on evdience before recommending a therapy is good. That is the standard all medical care should adhere to, and TCM/CAM should be no exception. But the other half is throwing the BS flag when warranted. The fact that TCM is old and from China is no reason to give it any more respect than other garbage "therapies" (homeopathy, naturopathy, accupuncture). It is nonsense.

Must be nice to live in such a monochromatic world. The fact of the matter is that what you say is never going to happen because patients have the right to make their own choices. You can alienate a patient by spouting all that self-righteous anti-TCM/CAM stuff, or you can at least be sympathetic so that you can steer your patient away from the truly harmful TCM/CAM stuff. Let's not throw the baby out with the bathwater.