The steady growth in the use of Complementary Medicine (CM) is caused by one main role player – the public! Why? We have been swayed into buying the stuff, and we do this because of the massive and effective marketing campaign targeting the publics’ weaknesses and by creating distrust in conventional medicine. But there is another aspect to this complicated issue. Scientists are usually ranked near the top of the most trusted professions list, amongst nurses and teachers, and quite predictably lawyers are usually near the bottom of this list. So we tend to trust that what a professor say will in all likelihood be the truth. I have no doubt that this trust is well placed in scientists operating in many of the diverse fields of science, but is our trust warranted when it comes to scientists in the field of CM? Let us look at one simple example.
Traditional Chinese Medicine (TCM) “holds that the body’s vital energy (chi or qi) circulates through channels, called meridians, that have branches connected to bodily organs and functions”. By manipulating these meridians (e.g. acupuncture) or increasing/decreasing the flow of energy (e.g. herbal treatments) disease can be prevented or the sick can be healed. TCM theory and practice has been discredited by the scientific community as dating from the pre-scientific era. The flow of energy, or the meridians they supposedly flow through, has never been observed or simply put, it doesn’t really exist.
A logical consequence of this is that different TCM practitioners will differ widely in the diagnosis and subsequent treatment that they prescribe to the same patient. Hence it is said that you will be prescribed 10 different herbs from 10 different practitioners. The TCM practitioners call this the “individualised care” (also holistic or whole-body) which they claim is lacking from conventional health care and hence they tailor their prescription for each patient. Not only does this make quality control next to impossible but for a scientist this simply means that there is no real science behind diagnosis and treatment – this by itself is very dangerous but not surprising, given the pre-scientific ideas that TCM is based on.
This aspect of individualised treatment has been studied by the National Institute of Complementary Medicine at Western Sydney University and the results confirmed what most scientists already know. Individually tailoring a combination of herbs has no extra benefit, and is even inferior, compared to a standardised set of herbs. Now what does this mean?
- There are herbs that may contain useful medicinal compounds and deserves further scientific investigation.
- The TCM theory and practise is, as expected, invalid and it is at best a shotgun approach. Give a patient 20 different herbs and hopefully one of them will have some sort of positive effect (and ignore all the documented dangers).
Now most scientists will agree with these two points whereas scientists in the CM field will only devotedly agree with point 1. They will however vehemently object point 2 since it proves that the TCM theory and practice is indeed pre-scientific and that it is not based on science at all. It basically destroys their whole “scientific” field! Because CM research is more a religion than a science they will now have to get rid of this result in some way or the other. Falsifying data is difficult and risky – if you are caught you are out. So what do they do?
They publish their scientific findings in such a way that it actually looks like individualising TCM treatments are indeed working, whilst the most important finding was the fact that it doesn’t seem to be working. The exact opposite! But it doesn’t stop here. Now they have to go and sell TCM to the public because the public is the main role player in the explosive use of CM including TCM. During a radio interview this important issue of individualising TCM treatments came up and the response from Prof Alan Bensoussan, lead researcher in this study and also a registered Chinese herbal medicine practitioner and acupuncturist, to this question is quite revealing (interestingly, no conflict of interest was declared in this publication). Below the unedited transcript (interesting part in bold).
“…But more and more sufferers of irritable bowel syndrome are now trying alternative treatments. Dr Anna Guo has over 30 years experience and extensive qualifications in both Western medicine and traditional Chinese medicine. She specialised in gastroenterology in China. She treats IBS in her Chinese herbal practice in Sydney, and says she has a very high success rate.
Anna Guo: In Chinese medicine they’re related to the liver, spleen and sometimes they’re related to the yin and yang and balance. So when we use some Chinese herbs to smooth the liver, strengthen the liver and improve the digestive system, and then the symptoms will go and they’re good for the general health too.
Lynne Malcolm: But it’s not right for everybody? Do some people just not respond to Chinese medicine?
Anna Guo: Yes, some people not so sensitive to the herbs, that’s true. Just effective rates about 80%.
Lynne Malcolm: OK, well in front of us we have some bowls of different herbs. Can we just describe what each one is? OK, so we’ve got a very bright orange-looking one here all cut up in slices. What’s this?
Anna Guo: This is huang lian. This can gather from the heat from the stomach and the bowel.
Lynne Malcolm: And this one, it looks like a bark, it’s in a ring shape and it’s sliced up as well. Is that a bark from a tree?
Anna Guo: Yes, and that name is hou po. This herb can accurate the energy circulation, so very good to relieve some of the bloating of the stomach.
Lynne Malcolm: And this one, this is a long, looks like bones to me, what’s that one?
Anna Guo: That’s the dang shen, and they can improve the energy. So use of these herbs can supply the energy, improve the digestive problem.
Lynne Malcolm: And that’s from a plant too, I gather?
Anna Guo: Yes, that’s fungus plant, yes.
Lynne Malcolm: And this one, hard white sheets?
Anna Guo: This one actually is a fungus, but they are very good for the immune system, and they can get rid of some extra fluid, because the patients always they feel have the fluid retention.
Lynne Malcolm: So you would make a concoction, a mixture of all these herbs in different proportions, would you, for different patients?
Anna Guo: Yes, that’s right. Because in Chinese medicine we always fix the patient individually. All the different persons, they have the different conditions, different problems, and then we choose the right herbs for different persons.
Lynne Malcolm: How do you know that these herbs work and do you know how they work and why they work?
Anna Guo: I think is just from experience. You know in China, we already have 5,000 years experience on the herbs. Of course we study in the formal university, and we can get some experience from our teachers. And after we start our practice and we can get some experience from our practice too.
Nick Talley: Now I was a great sceptic about Chinese herbal medicine. So we set up a trial in conjunction with Alan Bensoussan, who’s one of Australia’s experts in the field at University of Western Sydney. We set up a trial to actually look at Chinese herbal medicine compared with placebo, with dummy preparations.
Lynne Malcolm: Gastroenterologist, Professor Nick Talley. The results of this trial were published in JAMA, the Journal of the American Medical Association in November last year. Alan Bensoussan.
Alan Bensoussan: Well overall we showed that patients who were receiving active treatment responded significantly better than those receiving placebo. The degree of improvement was estimated to be about two or three times that of the placebo.
Lynne Malcolm: Alan Bensoussan heads the Research Unit for Complementary Medicine at the University of Western Sydney. They run rigorous clinical trials on the effectiveness and safety of so-called alternative medicines.I asked him why they chose to evaluate Chinese herbs as a treatment for IBS
Alan Bensoussan: Chinese doctors use a different theoretical understanding of how the body works. To differentiate between patients that may, on the surface, appear to be exactly the same in the Western medical eye. So what Chinese medicine does is it actually tailors the treatment to some extent, much more specifically to the patient. So each patient would normally receive a very different set of herbs or a very different set of accupuncture points. And irritable bowel syndrome, because of its variety of clinical presentations, it lends itself ideally to testing this premise of Chinese medicine. So what we did that was very novel about this particular trial, is we actually set up one treatment group who were receiving a standard formulation in Chinese medicine, another treatment group who were receiving a sham formulation, something that smelt and tasted and looked like Chinese herbs, a placebo; and the third treatment group actually received tailor-made Chinese herb formulations. We wanted to test whether this tailoring was actually of any value at all. We do have to demonstrate that the herbs actually do work for this condition, and that had to be tested properly. I mean our outcomes were positive; active treatment did prove to be significantly better than the placebo. But having said that, that came as no surprise of course to Chinese medicine practitioners that were involved or even on the periphery of this trial. These herbs that were used in the trial, are used routinely in some of the largest public hospitals in the world for this condition.
Nick Talley: Now I was very surprised by the results. We actually showed that people with this combination of 20 different herbs, got better, compared to the placebo group. And it was a study that was done as well as we could to avoid bias in the results. Of course the trouble is, we need to confirm these results. And there’s one other issue: there are many Chinese herbs that are being used, and some of them actually have significant side effects. In fact some of them are potentially quite toxic. And people don’t realise this, they think that natural treatments shouldn’t have any problems, but in fact some natural treatments have significant potential problems. Still in the study we did, it did seem to work and it did seem to be safe over a 16 week period. So I’m impressed with this, and I must say it’s something that’s going to be followed up. But I’m not routinely prescribing Chinese herbs at the present time for irritable bowel, as I’d like to be sure of the long term safety, and also the long term treatment effects of the compounds.
Lynne Malcolm: Is it understood what the actual process is, and how these Chinese herbs work?
Nick Talley: No-one has the faintest idea how these herbs work. In fact I suspect probably only one or maybe two of these things are actually active, the rest of them are probably worthless. The trouble is, which two out of 20 might actually work, and how are they working? I just don’t know.”
We know that people suffering from certain medical conditions listen intently to these radio shows – specifically the elderly. We know of the long list of risks associated with the use of herbal remedies and most shockingly, the participants in this radio show also knows about these risks. The main scientific finding of their study is that individualising herbal treatments is inferior to a standardised herbal treatment and thus again proves that TCM theory and practice is not based on science but rather on a pre-scientific believe system. As a registered Chinese herbal medicine practitioner, this aspect has to be ignored because it destroys your practise and makes your research invalid. To mislead the public is not always what you say or write, but it is also the important information that you intentionally omit. If I make the statement that the public is intentionally being misled – would I be lying? The many reasons why they do this can be found here!
Much more to come