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What Is Traditional Chinese Medicine?

One of the themes of science-based medicine is to be suspicious of any form of medicine that is not science-based. In other words, beware of dodgy qualifiers placed before “medicine,” such as: “alternative”, “integrative”, or “complementary” – those that imply that something other than science or evidence is being used to determine which treatments are safe and effective. I would also include “traditional Chinese” medicine in the dodgy category.  A recent article defending Traditional Chinese Medicine (TCM) provides, ironically, an excellent argument for the rejection of TCM as a valid form of medicine. The authors, Jingqing Hua and Baoyan Liub, engage in a number of logical fallacies that are worth exploring.

Their introduction sets the tone:

Traditional Chinese medicine (TCM) has a history of thousands of years. It is formed by summarizing the precious experience of understanding life, maintaining health, and fighting diseases accumulated in daily life, production and medical practice. It not only has systematic theories, but also has abundant preventative and therapeutic methods for disease.

It may be trivially true that TCM has a long history, but it is hard to ignore that the placement of this statement at the beginning of a scientific article implies an argument from antiquity – that TCM should be taken seriously because of this long history. I would argue that this is actually a reason to be suspicious of TCM, for it derives from a pre-scientific largely superstition-based culture, similar in this way to the pre-scientific Western culture that produced the humoral (Galenic) theory of biology.

The next line is an admission that TCM is largely based on anecdotal information, described as the “precious experience” of life. This is a point that is often overlooked or not understood by proponents but central to the scientific/skeptical position – what is the value and predictive power of “precious experience” in developing a system of medicine?

I maintain that there are many good reasons to conclude that any system which derives from everyday experience is likely to be seriously flawed and almost entirely cut off from reality. Obvious short term effects, the lowest hanging fruit of observation, are likely to be reliable. Uncontrolled observation is a reasonable way to discover which plants, for example, are deadly poisons. This is likely to produce some false positives but few false negatives, which is fine for survival.

Other obvious effects, like nausea, diarrhea, and psychedelic effects are also easy to discover. Similarly it was probably obvious that people need to eat, breathe, and drink in order to stay healthy and alive. But records of pre-scientific thinking about health and disease shows that little else was.

Pre-scientific doctors thought, for example, that pus was a good thing, a sign that a wound was healing.  They also did not realize that removing blood from the body was harmful, because they did not understand the vital physiological effects of blood and had fanciful superstitious notions about its role in the body.

So there are severe practical limits to what uncontrolled life experiences could figure out about health and disease. Every culture figured out some basic things, like local plants that had some uses, how to treat some forms of trauma, and to midwife childbirth, but could not figure out the complexities of biology, physiology, anatomy,  biochemistry, genetics, infection and disease pathophysiology and epidemiology.

Understanding health and disease took a more sophisticated method of observing nature – science.

How, then, could a pre-scientific culture without any knowledge of modern biology and without the methods of science develop a valid and effective system of medicine? The answer is – they couldn’t. In addition, there is now a large body of psychological research showing the many ways in which people systematically deceive themselves when it comes to finding correlations and making assumptions about cause and effect.

There is nothing about the Chinese culture or the Chinese people that should make them exempt from these documented psychological effects, or that would make their culture unique among the world’s cultures in stumbling upon notions about health and illness that were actually correct. It is extreme cultural hubris to think otherwise. When the institution of medicine in the West incorporated scientific methods as the standard of determining which treatments were safe and effective, and in understanding disease, over time almost everything that constituted “traditional Western medicine” was overturned. The “precious experience” of centuries of Western medicine resulted in largely worthless or harmful treatments, from blood-letting to toxic mineral-based treatments.

The same is true for every other culture, including Asian culture. As evidence for this, in my opinion, is the very description of TCM given by the authors. They give a description of TCM philosophy, breaking it down into three components. The first is yin-yang:

According to the theory of yin–yang, all opposite matters in the universe, which are interrelated with each other or two opposite aspects within one matter, can be defined as yin or yang.

This is a “push-pull” philosophy of health – but it is just that, a philosophy. Nothing has been discovered in physiology that correlates with yin-yang, that would lead to the prediction that a yin-yang systems exists, or supports the existence or effects of yin-yang. It is just a made-up notion without any basis in physical reality – just like the balancing of the four humors of Galenic medicine.

Defenders of yin-yang, however, will often make superficial comparisons to any system in the body (and other areas of science) that has a basic duality or dichotomy. They then argue that this is “yin-yang”. However, such an interpretation renders yin-yang vague and non-specific enough to be worthless. As with the predictions of Nostradamus, humans are good at retrofitting – finding apparent correlations. Many systems in the body exist in a certain balance, and many systems are interrelated. Some of these systems may have two dominant components (sympathetic vs parasympathetic), but others have three or more (such as the complex interplay among the various neurotransmitters in the brain).

Any variable (blood pressure, heart rate, GI motility, temperature, etc,) can be either increased or decreased – an inherently dichotomous situation. So it is trivial to call any such variable evidence of “yin-yang”. But yin-yang does not have any specific existence, nor does it provide any specific insight into physiology. In has no more of a relationship to actual biology than Galenic medicine, which can be said to have contained the insight that the body contains a balance of various fluids. This is also true, but trivially and non-specifically so.

Next is the five phases:

The five phases theory defines the nature of matters based on the related characteristics of wood, fire, earth, metal, and water. The five phases maintain the generation and restriction relationship among them. TCM uses five phase theory to describe the relationship between five zang and their physiological function, five zang and structure and function of various parts of the human body, and also the correlation between each part of human body and nature and society.

Your liver, apparently, has the aspect of wood.  This is an elaborate belief system, just like astrology, and has as much validity. It is rather poetic, also like astrology, and one can understand how a pre-scientific society would develop such ideas in order to attempt to understand something as complex and mysterious as the human body and illness.

There is no reason to presume, however, that such a description offers any insight into how the body functions or how to approach or treat any particular ailment.  The authors give an example:

In the treatment of the syndrome of disharmony between the heart and kidney caused by deficiency of kidney-yin and hyperactivity of heart-fire, according to the law of ‘water restrains fire’, we can use the therapy of reducing fire and reinforcing water.

I would rather treat a problem with heart or kidney function based upon a good ‘ol reductionist view of heart and renal function, understanding the role of blood pressure, body fluids, kidney function and regulation, electrolytes, etc. The notion (“law”?) that water restrains fire does not seem to offer any insight into how to treat a pre-renal syndrome.

Finally there is the visceral and meridian theories, which constitute an alternate (meaning incorrect) way of understanding the organs of the body:

Also, combining visceral manifestation theory with yin–yang and five phase theory, TCM has formed its own understanding towards the law of physiological and pathological changes of the human body. For instance, the liver matches wood, and the spleen belongs to earth. The over-acting of wood will lead to over-restraining on earth. Thus, we can see patients with transverse invasion of the stagnated liver-qi attacking the spleen.

How exactly does stagnated liver-qi attck the spleen? How would this be diagnosed? What I am saying is – what is the reductionist understanding of these concepts? It is common for proponents of such alternate ways of knowing to denigrate reductionist science, but if a way of “understanding” how something works reflects reality, then it should make sense and hold up to the evidence all the way down.

“Reductionist” really just means deeper levels of understanding how the world works.  It should not be confused with “hyperreductionism” which means ignoring or minimizing higher order levels of organization and function. You cannot, for example, understand how the body works just from biochemisty, or even from studying single cells. You have to understand how tissues, organs, and the whole body works together.

Science, actually, takes the most holistic view of health and disease, for it attempts to understand how the body works at every level of organization, and recognizes the folly of ignoring any level. You cannot ignore how the system works together, nor can you ignore how the individual parts work all the way down to their most basic components.

Ancient philosophies of medicine, however, either ignore the deeper levels of function, or make up fanciful underlying concepts, like wood and earth, that have nothing to do with reality.

Finally they describe the meridians:

The meridians transport qi and blood all over the body, link up the upper and the lower, the inside and the surface of the human body, response and conduct the information.

Except, there is no evidence that the meridians actually exist. At the risk of sounding redundant, they are as made up and fictional as the ether, flogistum, Bigfoot, and unicorns. The linking of qi and blood is reflective of the fact that the notion of qi is historically tied to blood, and techniques such as acupuncture and cupping were also closely related to bleeding techniques that we are more familiar with from Galenic medicine.

This leads to the next section on therapeutics in TCM. Of course they discuss acupuncture and also moxibustion and massage, but give very quick descriptions. They state multiple times that these techniques “treat disease” – which is an odd and extraordinary claim for several reasons. There is, of course, no evidence that acupuncture or moxibustion alters the course of any disease. You have to believe in the notions of qi etc. described above to believe that there is any plausibility to the use of acupuncture for disease. Even for symptomatic treatment (the bulk of scientific acupuncture studies) the evidence is weak to negative.

The authors also describe TCM herbalism, stating:

Currently, there are over 12,800 types of Chinese medicinals known by people, including over 11,000 medicinal plants, over 1500 medicinal animals, and over 80 medicinal minerals. Also, there are approximately 1 million TCM prescriptions found.

This relates to my main point above – how could practitioners have sorted out the risks, benefit, side effects, interactions, indications, pharmacodynamics, and pharmacokinetics of 1 million preparations without using any systematic scientific methods? This would be a challenge for a modern scientific institution, and would have been impossible for any pre-scientific society. One has to either ignore this issue, or assume preternatural abilities on the part of TCM practitioners, at the very least making them immune to all the mechanisms of deception and bias that seem to plague modern ordinary humans.

All of this background is just a long windup to what appears to be the main point of this article – the challenge of studying these therapies and ideas with modern scientific methods. Those of us familiar with this line of reasoning can see the massive special pleading coming a mile away.

They outline five challenges to scientifically studying TCM – that TCM considers overall health (I guess rather than just one condition at a time), therapies require ongoing assessment and adjustment, multiple therapies are given simultaneously to work together, and there are multiple targets of therapy.

Let me turn this around a bit – assuming the premises of this reasoning are true (that TCM must include these higher levels of complexity) then it is true that TCM treatments would be difficult to study systematically. At the same time, however, they would make it very difficult (likely impossible) to derive any reliable conclusions about therapy from “precious experience”. I would argue that the same features that make TCM difficult to study in a controlled setting make it impossible to assess in an uncontrolled setting.

So how, then, can TCM practitioners have any practical knowledge about what therapies work and are appropriate in specific situations? Something akin to “magical intuition” is the only answer.

That point aside – it is difficult, but not impossible, to study such treatments. First, I disagree with the premise and believe it is just special pleading, an excuse for the lack of scientific evidence for TCM. In modern medicine we often use multiple treatments working together to address a complex syndrome. Each individual component, however, should contribute to the overall benefit, and should be able to demonstrate its contribution in controlled studies.

Any contribution too small to detect in clinical trials is probably too small to be of clinical significance. Also, even if we accept the premise that multiple treatments only work when given together, you can still study this in a controlled setting – by individualizing a holistic treatment plan and then giving it or a placebo substitute in a blinded fashion.

You may have noticed that I left off the fifth “challenge” to studying TCM (which is often used as an excuse for a lack of evidence). The authors write:

Finally, the cultural characteristic embodied in traditional Chinese medicine requires more consideration on ecological features of data in TCM when conducting statistical analysis.

I’m not sure what to make of that statement, and the authors give no further explanation. I would just point out that science – and reality – has no cultural characteristic. If something is true about the world, it is true no matter what culture you come from. The point of science is to be transparent and universal, so that anyone doing the same experiment, no matter what culture they come from, should have the same result.

Conclusion

TCM is a pre-scientific superstitious view of biology and illness, similar to the humoral theory of Galen, or the notions of any pre-scientific culture. It is strange and unscientific to treat TCM as anything else. Any individual diagnostic or treatment method within TCM should be evaluated according to standard principles of science and science-based medicine, and not given special treatment.

Posted in: Acupuncture, Energy Medicine, Science and Medicine

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50 thoughts on “What Is Traditional Chinese Medicine?

  1. windriven says:

    A personal observation having lived in China for a couple of years and maintaining business interests there: most Chinese routinely use a variety of herbs and potions and other elements of TCM. But confronted with real disease Chinese in the cities head straight for the hospital (one sees physicians there rather than in independent practices as is common in the US) where medicine is generally of the western variety. Chinese in the interior tend to be breathtakingly poor and have little alternative to folk remedies.

    In other words the Chinese of my acquaintance, presented with the opportunity, choose technological medicine over TCM when confronted with disease beyond the common cold. And for what it is worth, the medical care that I received in China seemed every bit as good as I am accustomed to in the US.

  2. WilliamLawrenceUtridge says:

    Delicious word salad…

    The thing is, even if yin-yang was somehow based on an actual system in the body, even if the originator of the theory of yin-yang was describing, in prescientific terms, the HPA axis, or thermoregulation, we’ve now got something better. We now understand the system itself, in a much more accurate and true way. So even if they were onto something, our understanding of that system has surpassed this “ancient wisdom” in the same way understanding of genes and DNA surpassed the original musings of Darwin and Mendel.

    Bigfoot is real of course; they’re lingering pockets of Neanderthals who can not be photographed with modern equipment. That’s how you know they’re real – because there’s no evidence!

    The link to “the notion of qi is historically tied to blood” appears to be dead by the by.

    (Editor’s note: Link is fixed)

  3. Scott says:

    I can see at least one important additional challenge to rigorously studying TCM. If the results are negative, then the investigators will be accused of racism and cultural insensitivity. Only positive results may be permitted. Which is an entirely untenable restriction under which to practice good science.

    Facts are facts the world over, but when it’s forbidden to take note of certain facts the system stops working right.

  4. rork says:

    Native american ethnobotany often shows the same plant used for 50 different indications, because in different areas folks come to different conclusions. Try Alternateleaf Dogwood at http://herb.umd.umich.edu/ for example.

  5. Prometheus says:

    The introductory sentence in this paper could be easily transformed to:

    “The Four Humors Theory of health and illness (FHT) has a history of thousands of years. It is formed by summarizing the precious experience of understanding life, maintaining health, and fighting diseases accumulated in daily life, production and medical practice. It not only has systematic theories, but also has abundant preventative and therapeutic methods for disease.”

    That transformed statement is equally true and equally irrelevant to the practise of medicine in the 21st (or even 20th) century.

    The Four Humors Theory is ancient, having originated (so it is thought) with ancient Egyptians before being codified (to some extent) by the Greeks ca. 400 BC. It was also formed by observations of life, health and disease. It also has systematic theories of health and disease and provides “rational” (in terms of its postulates) preventative and therapeutic methods.

    It is also – need this be said? – utterly wrong, just like TCM.

    It never fails to amaze me how people who buy the latest cell phone would want to use ancient and discredited systems of “medicine”. Yet, TCM, homeopathy and chiropractic flourish amid computers, cell phones and palm-sized satellite navigation systems.

    Prometheus

  6. nybgrus says:

    ~windriven:

    That jibes exactly with the stories of a classmate of mine who spent much time in China, with a specific focus on medical practices. Additionally, he has told me about how Mao instituted the revival of TCM as a way to placate the impoverished masses, whilst he and the other elites never used anything but the most modern “Western”medicine. Today, TCM continues in this route in addition to attracting gullible tourist dollars.

    He also recently burned his copy of “the Web has no weaver”

  7. cervantes says:

    “Yet, TCM, homeopathy and chiropractic flourish amid computers, cell phones and palm-sized satellite navigation systems.” So do religions, which are equally superstitious. Why should it be surprising? The vast majority of people subscribe to irrational beliefs of all sorts, in fact people who do not are stigmatized.

  8. Quill says:

    “He also recently burned his copy of ‘the Web has no weaver’”

    See, see? Fire does “restrain” wood! There must be something to this TCM afterall. ;-)

  9. cervantes says:

    I may vomit. Look what just hit my in-box:

    The Year of China and the Division of Biology and Medicine present

    Yin and Yang:

    Chinese Medicine in American Healthcare

    Wednesday, February 22, 2012

    Ted Kaptchuk, Keynote Speaker

    4:00 pm

    “Chinese Acupuncture, Ritual and Placebo: A Scientific Inquiry”

    Warren Alpert Medical School, Brown University

    222 Richmond Street

    The lecture will be followed by a panel discussion moderated by Ted Kaptchuk and featuring Robert Heffron, Cathy Kerr, Kevin Liou and John McGonigal. A dumpling and tea reception to follow.

    6:30 pm

    “Chinese Medicine in the Context of World History: A Personal Intellect Journey”

    Marcuvitz Auditorium, Sidney Frank Hall

    185 Meeting Street

    Ted Kaptchuk is a practitioner and scholar of traditional Chinese medicine and received a Doctorate in Oriental Medicine from the Chinese Oriental Medical College in Macau.

  10. Quill says:

    This is a question not just for Steven Novella but for anyone well-versed in the terminology of SBM. In this post and general discussions on SBM, I would like to know how the term pre-scientific is defined. In general usage it seems to be squishy and used by different groups of people to mean anything from changes in the mid 19th century to the early 17th century and is even referenced to the observations of Aristotle.

    As used in medicine in general and SBM in particular, what does pre-scientific mean?

  11. EricG says:

    I spent a year in Korea and had a friend develop some serious intestinal problems. he went to the doc, doc said, “stop drinking cold water.” he abided, took some pills (of mysterious content…more on that in a sec) and got no better. He eventually developed a fever…got real sick and went home. I told him, as we discussed the tragety of care, that he would probably be better after 4 days back home. he was. he had a bacterial ulcer (that may be redundant…) and got the proper care and was fine.

    My gf also had some of the same stomach issues (which were not as severe). she was given a prescription cocktail. she did her homework and laboriously discovered (using online sources) what they were. she was given 5 or 6 things ranging from an anti-diarreal (sp?) to a mild pain killer. and the toss-in-sage-korean-catch-all of ,”dont drink cold water.”

    Its strictly culture, which appears to be changing or has changed to some extent. the top-down, hierarchical, respect mandated “obey your elders right or wrong at any and all costs” has prevailing consequencs in just about every domain of life, not just who gets the big piece of chicken at dinner.

  12. Harriet Hall says:

    @Quill,
    According to Merriam-Webster, prescientific means “of, relating to, or having the characteristics of a period before the rise of modern science or a state prior to the application of the scientific method” I think that covers it pretty well. It can refer to a historical period or a contemporary system of thought.

  13. Quill says:

    @Dr. Hall: thank you! I will take it to mean in medicine (with no “dodgy qualifiers”) that pre-scientific means pretty much anything before the 17th century and a great deal of things before the latter part of the 19th century, before the standardization of methods leading to events like the validation of germ theory and the like.

    Having a precise definition is helpful to me when evaluating these arguments from antiquity. In terms of medicine, whether it was popular two thousand or five hundred years ago will likely make no difference.

    In terms of TCM I think it makes an interesting historical read, to look at how people attempted to frame their experiences and explain problems. They tried to come up with a theory of everything as it related to a human being in the cosmos and in my mind they achieved a kind of poetry. But as a modern method for treating illness it simply isn’t.

  14. pmoran says:

    — I would like to know how the term pre-scientific is defined —

    It is not easy. The four humors did have some basis in observations of reality, in that black bile, yellow bile, blood and phlegm were observable entities. When lacking anything better, it was perhaps not unreasonable to try and incorporate them into a theory of illness.

    Similarly, ancient Chinese physicians would have been aware of streptococcal lymphangitis, which provides an observational basis for the notion that the body possessed otherwise invisible channels through which something important flowed.

    So perhaps most cultures always had a mixture of science-like inquiry and reasoning and superstition. The escalation of medical discovery over the last few centuries was enabled by advances in other areas of science and waning priestly authority.

    China was perhaps (temporarily) held back over this critical period through its cultural isolation, and other cultural characteristics, including taboos against dissection of the body — (and even proper examination of it?).

  15. Harriet Hall says:

    @Quill,
    And a lot of things that are still happening, too. If people today are thinking like people did before the standardization of scientific methods, their thinking is pre-scientific even if it occurs in the 21st century.

  16. Harriet Hall says:

    @pmoran,
    “The four humors did have some basis in observations of reality… When lacking anything better, it was perhaps not unreasonable to try and incorporate them into a theory of illness.”

    Observations of reality and incorporating them into a theory may have been “reasonable” and may have been the best they could do, but they are not science. Simply observing reality and forming hypotheses can be either prescientific or the first stage of scientific inquiry. It remains prescientific unless systematic testing is added.

  17. Quill says:

    @ Dr. Hall: lol! Yes indeed. It has always been funny to me that “medieval” is so descriptive of the thinking of people alive right now.

    I’ve been working on coming up with some kind of efficient way to wade into the mass of medical information available to me. Looking out for these appeals to antiquity is a great help. Also is looking out for any kind of outright rejection or subtle qualifiers on causality and empiricism. If things just mysteriously appear or claim to be outside any known kinds of evidence then I think I’m relatively safe in moving on to something else.

    @ pmoran: thank you for those thoughts. I tend to think that the impulse to help others is ancient in a very good way and that these early societies were doing the best they could with what they had. It is also easy to imagine one of these “ancient” TCM practitioners being delighted to find out that there were “invisible” things called germs which could be dealt with. This seems in contrast to “modern” TCM people who seem to want to keep things as they were and refuse to realize that the microscope is not their enemy.

  18. Mark P says:

    Grammar Nazi alert: while the odd typo is acceptable, and we all make them, I would like to see the references to “alternate ways of knowing” etc changed to “alternative”.

    Alternate means “To pass back and forth from one state, action, or place to another”.

    Alternative means “The choice between two mutually exclusive possibilities” and it is alternative medicine that is of interesthere.

  19. kathy says:

    “It is common for proponents of such alternate ways of knowing to denigrate reductionist science, but if a way of “understanding” how something works reflects reality, then it should make sense and hold up to the evidence all the way down.”

    When proponents of CAM accuse scientists of being reductionist, I remind myself that real science (both medical and other varieties of science like ecology or meteorology) is integrated with the foundational sciences of physics and chemistry, and CAM usually is not. Science even integrates with something as deep down as mathematics (ie stats) … which is ignored or rubbished by the evangelists of the Kingdom of Woo.

    TRhis accusation makes me think of the old story of pointing fingers: when you point a finger at someone look at your hand … one finger points towards the one criticised and three fingers point back towards yourself. Old saying, maybe a cliche, but still valid (This is a piece of ancient Western wisdom, ahem!).

  20. BillyJoe says:

    “That’s how you know they’re real – because there’s no evidence!”

    That’s actually a reference to conspiracy theory.

  21. rmgw says:

    “over 1500 medicinal animals” …. (see your earlier, excellent entry on bear bile farming, for example).

    Still, it’s interesting that sorting the world into a binary – yin and yang – can correctly be identified as unscientific and ultimately unhelpful, but the binary human/animal goes unnoticed, so much is it part of our culture – namely, the part which allows us what Derrida calls the “non-criminal putting to death” of those in the dispreferred category.

  22. NYUDDS says:

    Interesting post. Two things: first, a slide show from Medscape that puts forth psychiatric syndromes that are hypothesized to be cultrually-based. Very new to me!

    http://www.medscape.com/features/slideshow/culture-synd?src=mp&spon=17

    Second, @ Cervantes: A little off-point, but IMHO, a wonderful treatment of NOMA by the late Stephen Jay Gould.
    http://www.stephenjaygould.org/library/gould_noma.html

  23. WilliamLawrenceUtridge says:

    cervantes – at least you get tea and dumplings. Traditional Chinese Medicine might be worthless, dangerous and harmful to endangered species – but Traditional Chinese Cooking is delicious. And sometimes harmful to endangered species.

    Quill, within medicine specifically I would say “prescientific” applies to basically everything before the germ theory of disease. If you want a date, peg it at 1847 when Semmelweis started washing his hands, and throw in Snow’s pump handle in 1854 followed by Pasteur in 1860 and Koch’s postulates in 1890. John Barry’s amazing book, The Great Influenza, does a fantastic job of providing an easy, readable overview of the growth of scientific medicine in the US, from the worst in the world to among, if not the best.

    Thanks to the eds for correcting the link!

  24. Please excuse the shameless self-promotion, but:

    In this post and general discussions on SBM, I would like to know how the term pre-scientific is defined.

    For a previous SBM discussion, see: http://www.sciencebasedmedicine.org/index.php/science-reason-ethics-and-modern-medicine-part-1/

    Scroll down to “An Essential, Very Short History of Science-Based Medicine.” It pretty much agrees with WLU’s statement above, but also mentions several discoveries and innovations that eventually led to true SBM.

    …he has told me about how Mao instituted the revival of TCM as a way to placate the impoverished masses, whilst he and the other elites never used anything but the most modern “Western”medicine.

    Correct: http://www.sciencebasedmedicine.org/index.php/acupuncture-anesthesia-a-proclamation-from-chairman-mao-part-iii/

    He also recently burned his copy of “the Web has no weaver”

    No wonder: http://www.sciencebasedmedicine.org/index.php/dummy-medicine-dummy-doctors-and-a-dummy-degree-part-2-1-harvard-medical-school-and-the-curious-case-of-ted-kaptchuk-omd-cont/

    Ted Kaptchuk is a practitioner and scholar of traditional Chinese medicine and received a Doctorate in Oriental Medicine from the Chinese Oriental Medical College in Macau.

    Nope, no doctorate: http://www.sciencebasedmedicine.org/index.php/dummy-medicine-dummy-doctors-and-a-dummy-degree-part-2-3-harvard-medical-school-and-the-curious-case-of-ted-kaptchuk-omd/

  25. Quill says:

    @WLU: thank you for the book recommendation. It looks like a very good read. Also thanks for your take on the dates. I wasn’t looking for a specific date but that is definitely a handy way of looking at it, especially if someone thrusts a pamphlet at me claiming that some fabulous “WonderCure” was favored by King Louis XIV of France.

    @Kimball Atwood: thank you for referencing the earlier post. (I’d looked in the archives but somehow missed that one.) It really is astonishing to contemplate how short a time science-based medicine has been around in relation to human history yet how much incredible good it has done. That article also brought up some fond memories. My great-grandfather was a doctor, graduating from what is now Washington University School of Medicine in 1903. My mother remembers his stories of having to convince people his “science” was just that and not some kind of witchcraft or miracle-based magic. The fact he actually helped and often cured people seemed to be rather convincing evidence. :-)

  26. BillyJoe says:

    Interestingly, in Neurologica, the same or similar article produced nearly 80 comments, mostly centered on the significance of yin yang in understanding wave particle duality (Bohr’s coat of arms depicts the yin yang symbol representing wave particle duality)

    http://theness.com/neurologicablog/index.php/tcm-aplogetics/

  27. 7119munro says:

    “Finally, the cultural characteristic embodied in traditional Chinese medicine requires more consideration on ecological features of data in TCM when conducting statistical analysis.”

    This last sentence seems to sum up the Chinese attitude towards TCM very well. I also think it’s something we should take into consideration when trying to understand why the Chinese stick so rigidly to these superstitions. I am certainly no scientist, but having lived in China for a number of years and having learnt Chinese to a decent level I hope I can at least help us all gain some insight into how the Chinese think about what is “theirs” and what is “ours”.

    Firstly, face. Face controls everything in China. I suppose the closest thing we have in the West would be called pride, or auctoritas/dignitas as the Romans called it. Face is ever-present and always in the minds of the Chinese. Losing face is the biggest shame in China. Through their education and overall feelings of superiority, the Chinese believe that anything Chinese is somehow better, or at least on a different level to things which are not Chinese. It’s not difficult to understand when you live in a country which for thousands of years was cut off from the rest of the world, only for the “western barbarians” (The British) to come and invade unprovoked. Face, when dealing with foreigners (Be they scientists, politicians etc.) , becomes twice as important. Whenever I try to bring up the topic of Chinese medicine with the locals here I usually just get a look of disdain and a patronising “Well, you just don’t understand”. Someone even said to me “Well, maybe Chinese people’s bodies are different to foreigner’s bodies”!!

    Secondly, many Chinese themselves admit that TCM is not scientific. They believe there are two types of science, that which can be observed and that which is outside of the realm of observable entities. (I know, I know…..).

    Finally, the argument from antiquity. The Chinese believe that because the system was introduced thousands of years ago (Incidentally, by the mythical yellow emperor who also invented tea and a load of other things) and is still in use today, it somehow must have a use. Again I’m usually met with a glance of derision when I tell them the importance of the scientific revolution and how every ancient civilisation had some form of folk medicine which was later disproven as merely superstition.

    In the end, I’m not sure if the Chinese truly believe Chinese medicine in their heart of hearts. But for the time being face and suspicion towards anything foreign will take precedence in the middle Kingdom.

  28. Earthman says:

    “How, then, could a pre-scientific culture without any knowledge of modern biology and without the methods of science develop a valid and effective system of medicine? The answer is – they couldn’t.”

    The ancient Greeks thought that from a few basic tenets, the low hanging fruit, it was possible by merely sitting and thinking about it for long enough that you could deduce all the features of the Universe. This was a foundation of Greek philosophy back in the early days. Of course they couldn’t deduce anything like as much as they thought they could with any accuracy, but that did not stop them trying.

    A common human failure that I observe is that people will think that a system, whatever system, is a lot simpler than it actually is, and they therefore think that ‘Common Sense’ can solve any problems that the system throws up. ‘Common Sense’ that has come from observation of the low hanging fruit. Often with disastrous or hilarious consequences. Politicians are some of the worst offenders.

    Science tells us to stop thinking in human terms about a system, because the human mind will trick and fool us into a false conclusion. It gives us methodologies by which this can be achieved. If you don’t follow rigorous scientific procedures you are going to be fooled.

    What I cannot understand is that the article which is the subject of this post seems to have been published in a journal of statistics in medicine. Where are the stats?

  29. JPZ says:

    Sorry to hijack this thread, but I did say I would be a gadfly here:

    Steve sez: “They tend to follow a similar pattern: put an essentially random assortment of vitamins, minerals, perhaps herbs and nutritional elements into a pill and then make whatever pseudo-health claims you want. Usually the claim is implied in the name of the product itself – sleepwell, or brainboost.”

    But the truth is:

    http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/DietarySupplements/ucm103340.htm

    This is his statement versus the actual government document, his lie versus the truth. Why do you accept the lie? Is it fun to only accept the opinion you find most agreeable? Test the opinion.

  30. Harriet Hall says:

    @JPZ,

    There is no lie there. The truth is that the products he describes do follow that pattern. Many of them make illegal claims that are not permitted under the DSHEA (the FDA doesn’t have the manpower or budget to prosecute them all), and others use testimonials and innuendo to persuade patients that their products have uses as medicines, thereby getting around the structure/function claim regulations.

  31. Roadstergal says:

    I hurt my lower back last week (a depressing moment – I never have had back issues before), and was diagnosed by the doc I went to see with sacroiliitis. The doc told me to ice it, take antinflammatories, stop with the running for a bit, and it’ll resolve itself. Fine and dandy. Then he tried to sell me on an acupuncturist, and I told him, thanks, I don’t need a placebo. He told me “I know a guy, down the street – he studied in China…” Well, so fucking what?

    It just makes me so depressed that an MD at Stanford tried to sell me on acupuncture. They should be ashamed.

  32. JPZ says:

    @HH

    So, because some companies make illegal claims, it is OK for Steve to lie about the law of the land? Again, I am finding a skeptic-bias when Steve and others (not you) are confronted with truth and the law. He lied to make it sound like it was OK to make those claims. How low will the other moderators on SBM sink to make it sound like they are proving their point?

    Yep, I can’t stand hypocrites who make sounds like they are skeptics, and deny that they have bias. They can accept science, or they can be in my gadfly sights.

    1. Harriet Hall says:

      @JPZ,

      In saying Steve “lied” you are not only wrong but out of line. I could return the compliment by saying you lied, but I’ll give you the benefit of the doubt and assume you misinterpreted what he wrote because of your pro-supplement bias. You are quoting Steve’s words from this article: http://www.sciencebasedmedicine.org/index.php/alpha-brain-whats-wrong-with-the-supplement-industry/ The article is factually correct and in it he accurately described the “law of the land.” I fully support what he said, so don’t try to separate me out by accusing others but “(not you).”

      You are not being a useful “gadfly” but distorting the truth and being very offensive.
      Enough is enough! If you have something to say that you can back up with references, fine; but please, no more outrageous insults! Play nice!

  33. Quill says:

    WilliamLawrenceUtridge recommended to me: “John Barry’s amazing book, The Great Influenza, does a fantastic job of providing an easy, readable overview of the growth of scientific medicine in the US, from the worst in the world to among, if not the best.”

    @WLU: I don’t know if you’ll see this but if so thank you again for this recommendation. I’m about half-way through this book and am enjoying and learning much. I’d also recommend it to anyone with an interest in medicine, science, history or someone who simply enjoys a gripping, good read.

  34. “Every culture figured out some basic things, like local plants that had some uses, how to treat some forms of trauma, and to midwife childbirth.”

    …and to midwife childbirth? Seriously? I thought this blog was free of gender biases because females write on it. I hate to think that this sentence is an implication that childbirth is basic and primitive when women tend to it. Childbirth by doctor and childbirth by midwife are essentially the same thing. A doctor can perform a C-section — that’s the only real difference. And with a nurse midwife involved, a C-section that necessitates a call to a doctor is often avoided because midwives are able to spend more time with the patient.

  35. Calli Arcale says:

    nobodyyouknow: I believe the implication was that people had learned some basic practices for assisting laboring women, not that there is anything primitive about doing so or that it’s bad if women are attending to it. So I think you’ve got it completely backwards. The point is that despite being hampered by prescientific ideas about the body, people did work out some important aspects of medical care such as midwifery, trauma care, and so on.

    (While we’re on the subject of ancient medicine, midwifery, and c-sections, it might be worth contemplating the rare c-sections performed in those days. The procedure was not survivable, and generally was only performed if the mother was already dead, or nearly so, as a last-ditch attempt to save the baby. Famously, we may recall MacDuff. Whether the real MacDuff came into the world that way or not, William Shakespeare definitely had heard of the process, for he made it into a plot device and wrote the wonderfully gory phrase “from my mother’s womb untimely ripped.”)

  36. JPZ says:

    @HH

    I re-read what Steve wrote looking for deeper meaning (or perhaps existentialism) to explain your assertion, but it wasn’t there. Please quote his text that adequately supports saying something is the “law of the land” when the actual law of the land says otherwise.

    Because, I provided the text of the US regulation which is the exact opposite of what Steve said (does that qualify as a reference – if I need to continue to shake up the status quo on “S”BM by challenging you to read simple references I provide like government regulations and PubMed citations – then so be it). Read his comment, read the law – to call that the “law of the land” is like saying murder is the “law of the land” in Mexico. Only a small percentage of the population is engaged in wanton murder in Mexico, but it must be “the law of the land” because it is happening regardless of what the actual laws may be. I suspect that Steve is quite familiar with the actual laws on dietary supplements given his comments on other threads. This was his hyperbole to deceive the readers – find me a more accurate word than lying, and I will be glad to use it.

    If person X says something, and person Y provides an independent, authoritative source that falsifies that statement, what do you call it? You just called it the truth. So, can “s”CAMer’s here say something and ignore the independent, authoritative source of criticism from “S”BMers and assert that their original statement is the truth?

    In all honesty, I would like to know where you feel I have exceeded the boundaries of logic.

  37. Harriet Hall says:

    @JPZ, You said this statement was a lie: “They tend to follow a similar pattern: put an essentially random assortment of vitamins, minerals, perhaps herbs and nutritional elements into a pill and then make whatever pseudo-health claims you want. Usually the claim is implied in the name of the product itself – sleepwell, or brainboost.”

    That is not a lie, but an accurate description. It is true of a great many products on the market. Not all of them, but then he didn’t say “all” products. These products comply with the law as long as they make only structure/function claims and avoid disease treatment/prevention claims. Often they do not comply with the law or manage to circumvent it by advertising with testimonials and innuendo. The FDA could prosecute those for violations, but they lack the funds and manpower to have a meaningful impact on the market.

    DSHEA describes the law. Steve described the reality of the marketplace. They are not “opposite” statements. Quoting the law does not falsify what he said. There is no lie.

  38. JPZ says:

    @HH

    How many times have “S”BM folks defended drug companies by saying that the illegal actions of a few companies does not invalidate the greater good done by pharmaceuticals (in fact, how many drug companies have not been the subject of federal censure or lawsuits?). Thus, I submit that the illegal actions of some fraction of the dietary supplement market does not incriminate the market segment as a whole.

    Thus, when Steve makes the “sins of the father” argument, “Usually the claim is implied in the name of the product itself – sleepwell, or brainboost” he is citing illegal activity to discredit the entire dietary supplement industry. And I provided the reference to show that he was citing illegal activity. He didn’t have to use the word “all” (which for some reason is OK for Scott to use inaccurately despite evidence to the contrary), Steve was characterizing the industry as a whole. As in saying the “Willie Horton” statement was not against all black people, because the ad just mentioned one name.

    If you feel it is an “accurate description” to take the illegal activities of a few companies as a characterization of the entire industry, then I have a lot of unpleasant examples to cite about “S”BM behavior in return. The fact that you don’t hold your supporters to the same standard as your critics could become a thread unto its own.

  39. JPZ says:

    @HH

    Also, following your logic:

    TRUE: Murder is illegal in Mexico

    TRUE: Narcotraficantes murder a lot of people

    Therefore, based on newspaper reports, murder is legal in Mexico

    Because, under your definition, the number of bad things you focus upon, is an accurate depiction of the whole. Oh wait, I forgot to ask if you work for Fox news.

  40. Harriet Hall says:

    @JPZ,
    This is getting to be ridiculous.
    No one has denied that the supplement industry produces some useful products (vitamins, for instance). Steve made a factual statement about an abuse that is all too common.

    Your sillygism is a complete fail. How about:
    TRUE: false advertising is illegal
    TRUE: supplement companies sometimes do illegal things and sometimes deceive the public without crossing the line into illegal.
    Therefore, companies are wrong when they do those things, the DSHEA is not effective in protecting the public, and the FDA is not effective in enforcing the DSHEA.

  41. JPZ says:

    @HH

    Please help me keep my facts and logic straight. So if I make a factual statement about an abuse that is illegal but widespread, then the abuse of it true and it is the law of the land? Contact the Supreme Court because robbery and murder are now the “law of the land.” Parse this logic for me. No? That is my point, why are you dodging it? I think this is the logic by which you are defending Steve’s statement.

    The letter of the law says that Steve’s statement, “…and then make whatever pseudo-health claims you want. Usually the claim is implied in the name of the product itself – sleepwell, or brainboost.” is false. I imagine the years Steve has invested in being rude to “s”CAMers would invalidate him claiming ignorance of the rules. Just like Steve tried to ignore Scott’s unscientific comments.

    Why is this still an open discussion? Steve says X, the law says Y, I call it a lie, and HH calls it ridiculous. I suppose this works in Republican candidate debates, but I expected better of “S”BM.

    And it is funny that you consider me rude. Your colleagues and commentators don’t hold back in being rude to people they consider “scammers,” and I don’t recall any of you moderators asking them to refrain from being so rude. So, it is just fine to open fire with all guns if you don’t like someone, but if someone returns the favor and has facts to back it up – they must be over the top all of the sudden.

    Let’s play “fact for fact” not “denial in defense of stupid comments because we need to maintain some decorum of “S”

  42. weing says:

    “And it is funny that you consider me rude.”
    I don’t consider you rude. Pathetic? Maybe. Rude? Nahh.

  43. Harriet Hall says:

    “Why is this still an open discussion?”

    Apparently because you didn’t understand my explanation.

    I don’t know if I can be any clearer, but I’ll try once more. DSHEA is “the law of the land”. Supplement companies regularly break the law or bend it. Saying so is not a lie.

  44. JPZ says:

    @HH

    Let’s go back over this again because you are trying to fake us out. Steve sez, “Usually the claim is implied in the name of the product itself – sleepwell, or brainboost.” But he also sez, “…allow “structure/function” claims without any requirement for evidence to back up the claims.” Remember, he states there is no “requirement” for evidence (the prior “name” part is self-evidence deception).

    Steve has had many years of criticism to learn that the law sez you can’t incorporate health claims into your product name: http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/DietarySupplements/ucm103340.htm. And his “statement” about there being “no” requirement IS a lie: http://www.fda.gov/Food/GuidanceComplianceRegulatoryInformation/GuidanceDocuments/DietarySupplements/ucm103340.htm. At what point can we call a lie on someone who isn’t a target of “S”BM criticism? You folks call CAM liars “sCAMers,” what do you call liars in your midst?

    If Steve knows what the authoritative truth is and states otherwise, I call that a lie. Steve did not stay many companies break the law, he said there is no “requirement for evidence” and implies, insidiously, that it is acceptable to break the law by using illegal product names. Are any of you going to parse that?

    Now, how is that an acceptable representation of “S”BM? I look forward to going on to my next example, but you folks blindly ducked my first example of “S”BM bias and are dancing around my second. How can I provide all the rest?

    Is this starting to come together for the audience, or is it still science versus “SB” medicine?

  45. Harriet Hall says:

    @JPZ,
    I think we are quibbling about matters of interpretation. DSHEA says there must be “substantiation” that there is a documented mechanism by which a nutrient or dietary ingredient acts to maintain such structure or function. Steve was specifically talking about products with “an essentially random assortment of vitamins, minerals, perhaps herbs and nutritional elements,” and the law does not require that the actual product or even the particular mixture has been tested or it has been shown to have any unique efficacy. And as I read the regulations, “sleepwell” or “brainboost” might pass muster while names with the word “cure” or the name of a disease would not.

    It would have been much better if you had “corrected” what you perceived as a mis-statement by quoting the relevant parts of the law instead of calling Steve a liar.

  46. JPZ says:

    @HH

    Awwww, nice excuse for Steve. Would you share that for a “scammer”? “Sleepwell” and “Brainboost” are specifically prohibited by their name. Read the regulation. That is a rather weak and circular reasoning to support your perspective.

    Interpretation? Easy way to dismiss discussions you may not like. You kind of blew through that “no” requirement aspect which ignores the law. He lied. Are you good with that? Did you question that? I would love to have “corrected” many of the examples I will provide, but I did try (documentation concurrent with revelation). And I could give one and 3/4 thought to what you folks would ignore (Dr. Seuss reference). The odd thing about citations is that they defenestrate “S”BM bias, totally.

  47. JPZ says:

    @HH

    I cannot count on both hands how many times I have politely “corrected” “s”BMer editors on obvious mistatements of the law (a polite dissenter on “s”BM is pish-posh ignored – note the examples I previously mentioned about the chiropractic heretics I don’t particularly like). As these so-called “s”BM “experts” are not novices to FDA law, I have to ask if they are willfully ignoring the actual regulations to influence your audience, or if they are liars. As Steven implied earlier, they (referring to Scott I think) might just be ignorant about the topics they discuss. Can we debate actual data, or will “s”BM” continue to show bias against truth even if there is data to falsify it?

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