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Cavalcade of Quackery: A Pantomine Horse

Last week I received the news release below that Steve Zeitzew, an orthopedic surgeon at VA Hospital Los Angeles and UCLA, sent to the Healthfraud list. It was sent to me by our colleague Liz Woeckner, President of the nonprofit research protection advocacy organization Citizens for Responsible Care in Research (CIRCARE) http://www.circare.org/
Ms. Woeckner sent it on with a cryptic comment, wondering if this action was a quid pro quo for the Chinese granting less than a dozen FDA “inspection stations” in Chinese cities. The latter is supposed to be an attempt to control the impurities and adulterants of Chinese herbal products.

But before proceeding, read for yourselves:

Monday, June 16, 2008 Contact: HHS Press Office

HHS Secretary and Chinese Minister of Health Sign Memorandum of Understanding on Traditional Chinese Medicine Research .

HHS Secretary Mike Leavitt today signed a memorandum of understanding with Chinese Vice Minister of Health Wang Guoqiang to foster collaboration between scientists in both countries in research on integrative and traditional Chinese medicine. The signing marks the opening of a two-day traditional Chinese medicine Research Roundtable at the National Institutes of Health (NIH). The roundtable features scientific presentations by researchers from China and the United States. Topics include the synthesis of Western medicine and traditional Chinese medicine, criteria for evaluating traditional Chinese medicine practices, and the application of modern scientific tools such as proteomics (the study of proteins) to the study of traditional Chinese medicine. “Many Americans incorporate alternative medical practices into their personal health care and are interested in the potential of a variety of traditional Chinese medicine approaches,” Secretary Leavitt said. “This project will advance our understanding of when and how to appropriately integrate traditional Chinese medicine with Western medical approaches to improve the health of the American and Chinese people.” The memorandum of understanding and the establishment of the international collaboration will aid in furthering scientific research on traditional Chinese medicine. Participants in the roundtable include a delegation from the Chinese State Administration on Traditional Chinese Medicine, academics from U.S. universities, and scientists and researchers from NIH, Indian Health Service and the Food and Drug Administration (FDA). Thirty-six percent of Americans use some form of complementary and alternative medicine (CAM), according to the 2002 National Health Interview Survey. In the United States, traditional Chinese medicine is an alternative medical system that is considered a part of complementary and alternative medicine. Integrative medicine combines mainstream medical practices with alternative medical practices. Traditional Chinese medicine involves numerous practices including acupuncture, tai chi, and herbal therapies. In 2007, NIH’s National Center for Complementary and Alternative Medicine (NCCAM) supported nearly $20 million in research on traditional Chinese medicine practices. Secretary Leavitt was joined at the signing by FDA Commissioner Andrew von Eschenbach, M.D., and NCCAM Director Josephine P. Briggs, M.D. The roundtable, which was coordinated by NCCAM, National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine and the Fogarty International Center, is being held in advance of the Fourth Session of the United States-China Strategic Economic Dialogue, which began today in Annapolis, Md.

Each sentence reveals one or more covert messages, errors, and contrary principles which science and medicine would ignore at risk of its demise. Sound over the top? Not really; alarming at least, if government functionaries continue to set health policies indirectly by sponsoring implausible research. .

First, they perpetuate the false dichotomy of “Western” and “TC” medicines. TCM can be compared to scientific medicine or to traditional (19th century and before) Euro-American folk and empirical medicine. They obviously have not been reading us. Do the organizers know what “synthesis of Western medicine and […TCM] means? Do they mean integrating? What?I know of know no self-identified analyst or student of TCM who can make a rational scientific presentation of TCM. One of TCM’s prominent proponents considers scientific controls to be forms of biases. [Kaptchuck T, Effect of interpretive bias on research evidence. BMJ. 2003 Jun 28;326(7404):1453-5;] A concept similar to “roadblocks” to the acceptance of “CAM” in the White House Commission charges. These conceptual deviations are post-modern language distortions, propaganda tools of the “CAM/IM“ movement.

I have pointed out that scientific characteristics were never a part of TCM. It lacked objective observation, consistency of observation, classification of observed phenomena, information storage, rationality and logic, consistent written transmission, objectively descriptive language, and a method for analysis or for interpretation. The system of elements , q’i, and yin/yang did not include a method for developing theories or independent natural conepts. TCM depended on empiricism, unreliable observation, was plagued by post hoc reasoning and causality error. It lacked a concept of error and a system for self-analysis to correct error. In fact, the culture discouraged analysis and criticism, considered to be bad form and disrespectful. TCM depended on individuals who rarely communicated in a formal, direct, manner. Add to that a system that accepted manipulation to suit the mood and concept of the observer or authority. I conclude that there is nothing in TCM to study scientifically. So now they want to develop scientific criteria to apply to their observations? Proteomics? On what? Actions of herbs? Words again fail me at the glaring presumptuousness and ignorance required to conceive such a project. (the “audacity of hope?” ;-).

“Many Americans incorporate alternative medical practices into their personal health care and are interested in the potential of a variety of traditional Chinese medicine approaches,” Secretary Leavitt said. “This project will advance our understanding of when and how to appropriately integrate traditional Chinese medicine with Western medical approaches to improve the health of the American and Chinese people.”

Here again, the assumptions have no basis. One assumption is that a significant number of Americans use [TCM.] Most surveys of use, even those biased favoring “CAM” show no single method reaching above 2 percent or so except for chiropractic and dietary supplements. Most methods lounge at the 1-3 percent level. These levels have plateaued over 2-3 decades even in the face of advertising and positive propaganda. Yet, I suppose that one percent of 300M being 3M, some sort of case could be made. But nothing but a jangling confusion of borderline and conflicting findings will result from further study. Unless they appoint people with critical analysis experience, a wide reading knowledge of the history and use of TCM, and a scientific view, their research conclusions will be indeterminate over the next 10 years or more. They will continue to rely on ideologues, advocates, self-deluded practitioners, and politically correct academics for advice and pronouncements.

They will probably exclude scientific or skeptical analysts, so there is no way they will develop a credible commentary on how best to integrate TCM and improve the health of the American and Chinese people. Well, they got it backwards again. It’s China that has to integrate scientific medicine over there. Their scientists and physicians clamor for it. The Chinese can begin with public health principles like inhibiting spitting in the streets, cleaning up their air (finally but it took the Olympics) personal hygiene, cleaning their toilets, improving their food handling methods, and other systematic changes. They might even follow their own modern physicians’ wishes, abandon their herbal industry and revive their prior inhibition of acupuncture/moxibustion methods instead of promoting the integration of TCM into our medical system.

The memorandum of understanding and the establishment of the international collaboration will aid in furthering scientific research on traditional Chinese medicine. Participants in the roundtable include a delegation from the Chinese State Administration on Traditional Chinese Medicine, academics from U.S. universities, and scientists and researchers from NIH, Indian Health Service and the Food and Drug Administration (FDA). Thirty-six percent of Americans use some form of complementary and alternative medicine (CAM), according to the 2002 National Health Interview Survey.

So there will be an international collaboration to “aid in furthering scientific research…” And they list the kinds of attendees at their 2-day conference. First, who is not there? Representation from the largest group of China’s medical community, its scientific physicians. Up to 6 years ago they outnumbered “TCM” physicians atleast 5:1, and I heard some say 10:1. The two communities of physicians practice by separate rules and traditions, the scientific ones practicing as do others throughout the world. Most of those do not even know much about TCM, and they rarely exchange professionally with the TCMers. They will not be there, of course. Who are the American “academics?” I’ll bet most will be people with NCCAM grants for TCM, some with published papers on acupuncture and TCM, but I doubt more than a token of unconflicted objective scientists, if any at all. Researchers from NIH? Bets from here they are advocates or NIH sponsored TCM researchers. Here we see the same internalized network of special interests at work again, naming one another to consulting positions. Indian health Service? Indian health Service?

They repeat the meaningless “thirty-six percent” figure, which has nothing to do with the number or percent who use TCM (<10 percent.) The true figures are published and they don’t quote them. Perfect for a presidential election year, right?

In the United States, traditional Chinese medicine is an alternative medical system that is considered a part of complementary and alternative medicine. Integrative medicine combines mainstream medical practices with alternative medical practices. Traditional Chinese medicine involves numerous practices including acupuncture, tai chi, and herbal therapies. In 2007, NIH’s National Center for Complementary and Alternative Medicine (NCCAM) supported nearly $20 million in research on traditional Chinese medicine practices.

Well, let’s let the reader incorporate this part…doesn’t add much to me except for the $20M.

OK, at this point you may have thought back up there someplace, how about the big picture? What the… is the federal government through HHS doing in this, mixing international politics with the independent and quasi-free medical scientific enterprise that is operating quite well, thank you? Changes in a scientific system come through a natural evolution based on the accumulation of bits of knowledge, with research proceeding on the basis of the preceding knowledge base. If one wants to study cultural folkway medicines and methods, research would have to be highly selective. One simply cannot study a system as a whole scientifically. That is one of “Holistic Medicine“ and “CAM‘s“ early complaints about “the Medical System,” that they claimed was structured so as to prejudice knowledge coming from traditional systems. Some even believed a conspiracy, constructed to exclude them. Neither can one study each method and material of the thousands in each tradition that is presented or discovered. The selection for research has to be based on the validity of reported observations of those methods most consilient with the scientific knowledge base. One might excuse some private business or foundation seeking some outlet for research funds and that has a personal or organizational (for profit) motive for doing some badly founded research. At least the funding source and even a profit motive would be open and apparent – as we say, transparent – even if we consider their projects highly implausible. But this attempt is a disguise – a pantomime horse hiding its real propulsion mechanism under a distracting cover.

What is HHS doing, using a cover of medical science and for what? The government doesn’t do such things without pressure from some group or perceived self-interest in negotiation. In this case, what are the respective interests? There could be several.

For China, the most apparent is awakening the American population to the hidden miracles of TCM – and the marketing of supplements. Ka Kit Hui, a practitioner in Santa Monica, Calif., been promoting TCM herbs for several decades. I debated him on the subject at Stanford in 1995 or so at which time he extolled the undiscovered miracles in TC herbal medicine. Again in a letter to the editor to JAMA in 1997 he predicted that TCM herbals would be the prime economic product of the 21st century. I dismissed the statement in a response, but here we are, nearly 1/10th the way through the century, and here is TCM herbalism making inroads. China must see a large market, a population at least a third of their’s, and in view of the differences in income, living standard, and disposable income, a market that is at least as large in dollars/yuens as China has at home – probably greater.

What motivates the US? For one, TCMers may be behind the effort. They are on a path toward legitimizing the OMD degree and licensing of TCM practice. They already have acupuncture licensure in a plurality of states. They have a dozen or more schools of TCM. The California state legislature several years ago dropped an attempt to standardize teaching in the California schools – a first step to a standard exam and thus an academic standard for licensure. But they will be back. It took naturopaths over 15 years to get their licensure and degree recognition – another history familiar to Kim Atwood and others. The rest of the ulicensed hordes are following through an accompanying though crippled series of Access to Medical Treatment Acts. They persist – getting bits here and there and then, in an alignment of the planets minute, achieving passage of licensure legislation that imprints their initials in gold.

The formation of the NCCAM was a major step for TCMers. Now an HHS officially- sanctioned 2 day conference opens the plausibility of studying more TCM just as acupuncture systematic reviews are showing indeterminacy to ineffectiveness, herbs are being found more dangerous than helpful, and products from the PRC being found adulterated with metals and with standard pharmaceuticals. A fly on the wall of certain congressmen and senators and of HHS director Leavitt could tell us a lot. (Here we go again with a FOI request.)

As for government sourced motives, as Ms. Woeckner suggested, we probably had to pay a price for the stationing of FDA offices in Chinese cities. I still fail to see what they can do about adulteration of products, much of which could be shifted to way stations in Taiwan or in the US.

Unless someone on the inside squeals or finds that whistle to blow, seems to me we are getting taken to the cleaners again. At least this time it isn’t nuclear secrets given away by a Secretary of Commerce (Hazel O’Leary 10-12 years ago) or nuclear and missile technology sales OK’d by a greedy industry CEO and an unnamed agency as Chinese influence money came through in the 1996 election.

Oh, I think I’m getting it. We graciously level the military playing field in the interest of world peace by sharing nuclear and missile technology with China in return for political contributions. We get stripes and chevrons from the public and press. Then we help level the health playing field, increasing China’s level by sharing scientific advances with Chinese medical authorities and then finance the research. We accept a lowering of American health and medical standards by adopting some of China’s methods. Ya gotta balance those equations.

And finally,

The roundtable, which was coordinated by NCCAM, National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine and the Fogarty International Center, is being held in advance of the Fourth Session of the United States-China Strategic Economic Dialogue, which began today in Annapolis, Md.

Oh.

Posted in: Acupuncture, Clinical Trials, Herbs & Supplements, Science and Medicine

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