Qi Spot

A buzz topic now is the translation of the government label “No Approved Therapeutic Claims” into Filipino.  The term “No Approved Therapeutic Claims” was used for “food supplements” – a blanket term for non-big pharma produced products, usually “natural” or “herbal” medicine.

“No Approved Therapeutic Claims” thus means – “the claims of these products are not validated by the BFAD/FDA (Bureau of Food and Drugs, now renamed Food and Drug Administration).  What happens then is I can market a “natural” product as a “food supplement” and not as a medicine and it doesn’t have to go through same research as big pharma products.

The problem on this end is that there is a myriad of lousy products out there.  I am an advocate of Chinese herbal medicine but I am also the first to caution against lousy products that only end up harming the patient and the reputation of Chinese medicine.  in China, you see news about companies being penalized for putting out lousy products.  What about us?

Health Secretary Esperanza Cabral has good intentions.  We should be protected from bogus products.  I however, do not agree with the new translation for food supplement “warnings”.  I shan’t print the Filipino version here, but I can tell you it means “this product is not medicine and cannot cure any disease.”

This is obviously where I have a beef.

As a Chinese medicine doctor, I cannot agree that just because something is not produced by Big Pharma, it cannot be considered, “medicine.”  The American Heritage Dictionary defines medicine as “An agent, such as a drug, used to treat disease or injury.”  Note, it says an agent, SUCH AS a drug.  This means that there are other agents, while NOT drugs, that can be used to treat disease or injury.

To the Chinese, one of the most important agents are not just food “supplements”, but food itself.

Sun Simiao is known as the “Yao Wang” or “King of Medicinals”.  He is famous for a book entitled “Prescriptions Worth a Thousand Gold”.  Yet here is this important quote from him:

“Doctors should first understand the cause of disease, then treat it with diet. (Herbal) Medicine should only be used if diet fails” – Sun Simiao

Wow, the “King of Medicinals”, famous for life saving herbal prescriptions… recommends DIETARY therapy?!!  Good luck hearing that from Big Pharma.

Unfortunately this applies to "herbal medicine" product hawkers also. Image by Mike Adams. http://www.naturalnews.com/021638_conventional_medicine_quackery.html

Anyway my final thoughts are these:

1) We should not put down the idea of “food as medicine” as it is actually more effective for a lot of common, everyday problems.

2) The Chinese have this down to a science and I’ll be darned  - the stuff works.  Click http://www.meridianpress.net/intro.html for more info.

3) At the same time, a lot of food supplement products out there are just bunk.  Better not to rely on products made by people who just want your money.  Do your homework.  Pick a tradition of diet therapy (western, Chinese, whatever) and stick to it.

4) Don’t think that one herb or one fruit or one vegetable will solve all your ills.  Make lifestyle adjustments as well.

Now I’m off to get a nice porridge breakfast.  Be well!

One of the greatest frauds being intentionally perpetuated by some unscrupulous agents on both eastern and western medical “sides” is the idea that the two are mutually exclusive and never shall the two meet.  If one’s motivation is merely to profit from the medicine then it stands to benefit the practitioner to see the other side as “competition” and try to discredit it.  On the other hand, if one has in mind the benefit of the patient, then I believe one must at least be open to what the other side shall contribute.

Now THIS kind of West vs East I heartily encourage!

On the “alternative” medicine side in general, there is a conscious effort to paint “Big Pharma” as some evil, money-grubbing organization deliberately poisoning the population.

On the “conventional” or western side, there is an effort by a powerful few to brand alternatives as unscientific, or at the very least, incompatible with conventional medicine.

Both are lurid extremes hurting both sides and ultimately the patient.

I acknowledge that it is difficult to reconcile apparently conflicting ideas.  Some acupuncture instructors, when training western MDs, sometimes begin their didactics by saying that the MD must first “forget” western medicine to appreciate eastern medicine.  Boulderdash.

On the other hand, I remember some of my western medicine professors in university commenting on how “primitive” Chinese medicine seems because of Chinese medicine’s use of “nature” terms in it’s vocabulary such as “wind”, “cold” and “dampness”.  It is conveniently forgotten that the root word for the western medical term “inflammation” is in fact, “flame”.

In a spirited email exchange, I was warned that I, being biased towards acupuncture (and freely admitting it, although I am not biased because of financial reasons – I could make a heckuvalot more money as a pure western MD with all the drug company money and laboratory test kickbacks…) might suffer from “cognitive dissonance” when faced with “evidence” that acupuncture apparently doesn’t work.

So what is “cognitive dissonance”?

Changingminds.org defines it thus:

This is the feeling of uncomfortable tension which comes from holding two conflicting thoughts in the mind at the same time.

Dissonance increases with:

• The importance of the subject to us.
• How strongly the dissonant thoughts conflict.
• Our inability to rationalize and explain away the conflict.

Dissonance is often strong when we believe something about ourselves and then do something against that belief. If I believe I am good but do something bad, then the discomfort I feel as a result is cognitive dissonance.

Cognitive dissonance is a very powerful motivator which will often lead us to change one or other of the conflicting belief or action. The discomfort often feels like a tension between the two opposing thoughts. To release the tension we can take one of three actions:

• Change our behavior.
• Justify our behavior by changing the conflicting cognition.
• Justify our behavior by adding new cognitions.

Unfortunately for skeptics I do not feel any cognitive dissonance in my practice of medicine and with the research.  It is because I realize that I am not God. I do not know everything.  No one knows everything.  What we know are bits and pieces of things, and even how they fit together is subject to personal, collective societal and cultural bias. I adapt the attitude of St. Thomas Aquinas thus, as quoted by William G. Most:

Father William G. Most

Let us imagine that this theologian is standing on the circumference of a circle. From each of two or more points on the circumference, he tries to draw a line that will reach the center of the circle, that is, the true solution. If he has done his work well, all lines will come to a focus in the center.What will a good theologian do if not all the lines seem to focus? First, he will recheck his work for possible errors. But what should he do if he finds no error? If he is following theological rather than philosophical method, he will not try to make one line focus with another line. Rather he will say: “Now we are in theology, in lofty divine matters. It is not strange if mysteries appear. Therefore, even though I cannot see how to reconcile two lines, yet I must hold both truths.” And so, he will confess simply that he cannot go further.

(Most, William G. Grace, Predestination and the Salvific Will of God, accessed online  April 3, 2010 http://www.catholicculture.org/culture/library/most/getchap.cfm?WorkNum=214&ChapNum=4)

We are not theologians yes, and we are not dealing with “lofty divine matters”.  However the attitude should be the same. What happens if the lines don’t seem to focus? First we check for errors.

Thousands of years of experience shows that inserting a needle in acupoint Hegu relieves pain in general, and the effects are supposedly different depending on the manipulation and the patient condition.  I am but one physician, but I have duplicated this in the clinic.  I know many others who have.  Acupuncture is now accepted in many conventional hospitals in the United States to assist in childbirth (email correspondence with Dr. Eleonor Lazo, MD) Yet the skeptics who would destroy any possible synergy between the two medical traditions would try to use statistics to bash us. They say research shows that it doesn’t work.  When we show them research that shows acupuncture works, they’ll always find something to put it down, such as sample size, or it’s just a preliminary study etc etc, utterly forgetting their own sins (http://qi-spot.com/2010/02/21/another-big-pharma-cover-up/, http://qi-spot.com/2010/02/22/more-magic-numbers-this-time-its-celebrex/) And now apparently Lipitor causes increase in blood sugar too!  So much for peer review.

Is it too much for me, therefore, to suggest that when statistics apparently contradict clinical experience, we examine the statistics first?   It seems to me that when acupuncture is shown to work, the studies are supposedly “faulty” yet perfectly alright when the opposite is apparently shown.  My last post (http://qi-spot.com/2010/03/30/how-to-research-acupuncture/) shows why I believe current research paradigms for acupuncture are imperfect, thus leading to apparent conflicts.

The second problem is how we perceive if something “works”.  Most studies try to compare a treatment to the placebo effect.  I think the placebo effect is like St. Jude Thaddeus – getting a bad rap because of nomenclature.  Selling something known to be placebo is bad – you’re cheating customers.  Encouraging the placebo effect with good bedside manner – is that bad?  Now the argument is that acupuncture is “just a placebo”.  How can acupuncture be just a placebo when there are many studies (I refer the reader to http://www.acupuncture.com.au/articles/archive.html because I am too lazy to cut and paste them now) that show the specific physiological mechanisms of how it works?  A placebo by definition doesn’t do anything.  Acupuncture does something.  The question is is that something it does good?  As I have blogged before, improved sleep is good.  Easier walking is good.  Regular bowel movement is good. More energy is good. Decreased pain is good.  It had previously been pointed out that western medicine by definition should have a greater “placebo effect” due to cultural bias.  Yet acupuncture can work where western medicine doesn’t.  So much for “placebo”.

I also examine motivation.  What is my end point? To prove acupuncture works? No.  I believe it does.  To prove it doesn’t work?  Well, I’m not OUT to prove it doesn’t work, but I AM on the lookout to see where it works best, and where it sucks.  How? By personal study, reading both eastern and western medical journals (although I ignore 60s and 70s Chinese studies as those are ridiculously biased – hello cultural revolution!) By learning from the experiences of clinicians (I think it’s obvious I am biased towards the clinical experiences of great practitioners – lots of clinical pearls there) and from personal experience (I’ve developed some acupuncture manipulation tricks of my own ha ha).   I put a LOT of value on genuine clinical experience by great thinkers.  Edward Jenner was initially ridiculed for proposing his cowpox innoculation theory to protect against smallpox, because it went against the theory of the time.  Yet he was adamant because he was backed by clinical experience.

Edward Jenner was ridiculed for his ideas, as seen in this contemporary cartoon. (Click to enlarge)

If one is out on a witch hunt, to prove Chinese medicine doesn’t work, then everything you see will be filtered through that lens.  The same accusation can be made against me, that I see everything differently because I believe Chinese medicine works.  In that sense, we’re all bothered by cognitive dissonance!  Skeptics try to rationalize their position by citing statistics (which we know can be manipulated).  We rationalize our position by citing different statistics (which again, we acknowledge are manipulable).

I guess where I’m going with this is: unless we be like what William G. Most describes: true lovers of knowledge acknowledging our intellect is limited, we’ll be going nowhere.  In the meantime, what I do often (of course not always) works for my patients, the advice I give them based on Chinese medicine principles often (of course not always -THAT would be true placebo) works.  So if it ain’t broke, don’t fix it.