Acupuncture and Traditional Chinese Medicine: Going Mainstream?
A new patient came into my clinic not too long ago for a consultation. Now, this is not an unusual event. The unusual event was the fact that, after our conversation, she asked, “Doc, so after studying acupuncture, do you still practice traditional medicine?”
It took me all of ten seconds to overcome my instinct to say, “aren’t I practicing traditional medicine?” and to realize that my patient had a totally different idea as to what traditional medicine means. By traditional medicine she had meant what we normally call western medicine or conventional medicine. It got me thinking more though.
Is Acupuncture and Traditional Chinese Medicine mainstream or fringe medicine?
Who is to say what is alternative or not? Who is to say what is conventional or not?
After all, were not techniques that were considered mainstream a century ago now considered quackery? Were not ideas laughed at a short time ago now considered standard practice?
Consider the case of Dr. Ignaz Semmelweis (1818-1865).
Semmelweis was a Obstetrician-Gynecologist at a time when the germ theory of disease was not yet formulated. As such, handwashing and antiseptic techniques were not the norm. Therefore, infections after giving birth were commonplace, with about a third of mothers dying from them. “Childbed Fever” was a bane, but with no realizable cause.
Semmelweis, however, made astute observations that led him to a practical solution.
According to wikipedia (link) Semmelweis had observed that the difference between two clinics under his supervision lay not in any other variable except in the personnel. One clinic manned by medical students had ridiculous fatality rates while the other was manned by midwives in training. The difference was that medical students would dissect corpses for anatomy lessons then go to take care of childbirths without so much as wiping the putrid gunk off their hands.
Semmelweis then concluded that since a chlorine solution was able to get rid of the smell of rotting corpses, washing one’s hands with them before handling patients would, in theory, destroy whatever substance it was on the cadavers that caused the fever. Remember, no germ theory yet. Incidentally, the Chinese had known of such things a long time before this and called it “pestilential qi”, but I digress.
The results were that mortality rates had gone down by 90%. NINETY PERCENT!
Ignaz Semmelwies. Photo courtesy of Wikipedia
So what did Semmelweis get? Some royal award? A distinction? Riches and fortune?
Despite various publications of results where hand-washing reduced mortality to below 1%, Semmelweis’s observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Some doctors were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings. Semmelweis’s practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory and Joseph Lister, acting on the French microbiologist’s research, practiced and operated, using hygienic methods, with great success. In 1865, Semmelweis was committed to an asylum, where he died at age 47 after being beaten by the guards, only 14 days after he was committed. (from wikipedia)
So let me get this straight. Semmelweis was able to HELP people, but since he could not match his observations with medical theory at the time, he was considered a quack.
(Incidentally, many current scammers – see my previous post like to compare themselves to Dr. Semmelweis. That’s insulting to Dr. Semmelweis. He had actual clinical success backed up by statistics to support his claims, even if he could not explain his results.
Anyway the point is that what is considered quackery today may be standard treatment tomorrow.
But back to definitions. What IS standard treatment? Even THAT may vary from country to country.
My wife is from mainland China. During her youth a few years ago, she was used to taking Chinese herbs. She never even took anything western until college. Can we not say that for her, standard treatment is Traditional Chinese Medicine and everything else is the alternative?
But China now is different. For many youths, Western Medicine is first line.
The point? It’s relative. Even the World Health Organization agrees: (link)
Traditional medicine Traditional medicine is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. (emphasis mine) Complementary/alternative medicine (CAM) The terms “complementary medicine” or “alternative medicine” are used inter-changeably with traditional medicine in some countries. They refer to a broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system. Traditional use of herbal medicines Traditional use of herbal medicines refers to the long historical use of these medicines. Their use is well established and widely acknowledged to be safe and effective, and may be accepted by national authorities.
Just what is “conventional”? Image by renjith krishnan, courtesy freedigitalphotos.net
Note that the definitions are clear. The definition of traditional medicine emphasizes the following:
1) Knowledge, Skills and Practices…
It’s not just the modalities. It’s also the theory behind the modalities. To demonstrate what I mean, think about acupuncture. Acupuncture is a modality. It is NOT a system of medicine. It is erroneous to say that acupuncture in itself is traditional. Some acupuncturists select points based on modern medicine’s knowledge of spinal segments and dermatomes. Would you say that this is “traditonal”?
These days any scammer with an invention will claim tradition as his safety net. According to the WHO, something is not traditional if it’s not indigenous to a country. Hence, Chinese medicine is obviously traditional in China. Is it traditional in the United States? In the Philippines?
3) Long historical use
Note the word “use.” There are times when a herb is promoted outside of it’s customary or historical context. These usually result in disaster. Take into account the case of Ma Huang (Herba ephedrae). In Chinese Medicine, it is used specifically for certain presentations of flu-like illness. The literature is very very specific about when to stop using it. In this case, it strongly promotes perspiration and urination and it’s administration is to be stopped once the patient starts to perspire. However, some (and I am not ashamed to use strong language here) posers who think they know everything used it for weight loss. Disaster. Now it’s banned in the United States.
Now let’s see how the WHO defines “alternative”.
1) Not part of a country’s own tradition
2) Not integrated into the dominant health care system
By these definitions, Traditional Chinese Medicine is alternative in countries where Chinese culture is not predominant. Obviously in the United States, acupuncture is alternative, but what about Asian countries like the Philippines? There is no question that Philippine culture is at least influenced by TCM, is there?
The more definitive variable is if TCM is integrated into the dominant health care system. The argument for this is the fact that the Philippines has a law mandating the integration of traditional medicine into the national health care system. This is the Traditional Medicine Act of 1997 or Republc Act 8423. (link)
Section 2. Declaration of Policy. – It is hereby declared the policy of the State to improve the quality and delivery of health care services to the Filipino people through the development of traditional and alternative health care and its integration into the national health care delivery system. (emphasis mine)
Hence, Philippine law says that traditional and alternative medicine are to be integrated into the national health care system.
Conclusion: TCM and by consequence, acupuncture are still arguably alternative, but yes they are now mainstream.
Did you hear that skeptics? According to the WHO, and according to Philippine law, Traditional Chinese Medicine is MAINSTREAM!!!
Ciao and happy healing!
http://www.who.int/medicines/areas/traditional/definitions/en/ (accessed October 30, 2013)
http://en.wikipedia.org/wiki/Ignaz_Semmelweis (accessed October 30, 2013)
http://www.lawphil.net/statutes/repacts/ra1997/ra_8423_1997.html (accessed October 30, 2013)