Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
This post has been translated into Belorussian..
Chinese medicine and herbal medicine are in the news at the moment. There is a real risk that the government could endorse them by accepting the Pittilo report.
In my view traditional Chinese medicine endangers people. The proposed ‘regulation’ would do nothing to protect the public. Quite on the contrary, it would add to the dangers, by giving an official stamp of approval while doing nothing for safety.
The government’s idea of improving safety is to make sure that practitioners are ‘properly trained’. But it is the qualifications that cause the danger in the first place. The courses teach ideas that are plain wrong and often really dangerous.
Why have government (and some universities) not noticed this? That’s easy to see. Governments, quangos and university validation committees simply don’t look. They tick boxes but never ask what actually goes on. Here’s some examples of what goes on for them to think about. They show clearly the sort of dangerous rubbish that is taught on some of these ‘degrees’.
These particular slides are from the University of Westminster, but similar courses exist in only too many other places. Watch this space for more details on courses at Edinburgh Napier University, Middlesex University and the University of East London
Just a lot of old myths. Sheer gobbledygook,
SO much for a couple of centuries of physiology,
It gets worse.
Plain wrong.
Curious indeed. The fantasy gobbledygook gets worse.
Now it is getting utterly silly. Teaching students that the brain is made of marrow is not just absurd, but desperately dangerous for anyone unlucky (or stupid) enough to go to such a person when they are ill.
Here’s another herbal lecture., and this time the topic is serious. Cancer.
Herbal approaches for patients with cancer.
I’ve removed the name of the teacher to spare her the acute embarrassment of having these dangerous fantasies revealed. The fact that she probably believes them is not a sufficient excuse for endangering the public. There is certainly no excuse for the university allowing this stuff to be taught as part of a BSc (Hons).
First get them scared with some bad statistics.
No fuss there about distinguishing incidence, age-standardisation and death rates. And no reference. Perhaps a reference to the simple explanation of statistics at Cancer Research UK might help? Perhaps this slide would have been better (from CDC). Seems there is some mistake in slide 2.
Straight on to a truly disgraceful statement in slide 3
The is outrageous and very possibly illegal under the Cancer Act (1939). It certainly poses a huge danger to patients. It is a direct incentive to make illegal, and untrue claims by using weasel words in an attempt to stay just on the right side of the law. But that, of course, is standard practice in alternative medicine,
Slide 11 is mostly meaningless. “Strengthen vitality” sounds good but means nothing. And “enhancing the immune system” is what alternative medicine folks always say when they can think of nothing else. Its meaning is ill-defined and there is no reason to think that any herbs do it.
The idea of a ‘tonic’ was actually quite common in real medicine in the 1950s. The term slowly vanished as it was realised that it was a figment of the imagination. In the fantasy world of alternative medicine, it lives on.
Detoxification, a marketing term not a medical one, has been extensively debunked quite recently. The use of the word by The Prince of Wales’ company, Duchy Originals recently fell foul of the Advertising Standards Authority, and his herbal ‘remedies’ were zapped by the MHRA (Medicines and Health Regulatory Authority).
And of course the antioxidant myth is a long-disproved hypothesis that has become a mere marketing term.
“Inhibits the recurrence of cancer”! That sounds terrific. But if it is so good why is it not even mentioned in the two main resources for information about herbs?
In the UK we have the National Library for Health Complementary and Alternative Medicine Specialist Library (NeLCAM), now a part of NHS Evidence. It was launched in 2006. The clinical lead was none other than Peter Fisher, clinical director of the Royal London Homeopathic Hospital, and the Queen’s homeopathic physician. The library was developed with the School of Integrated Health at the University of Westminster (where this particular slide was shown to undergraduates). Nobody could accuse these people of being hostile to magic medicine,
It seems odd, then, that NeLCAM does not seem to thnk to think that Centella asiatica, is even worth mentioning.
In the USA we have the National Center for Alternative and Complementary Medicine (NCCAM), an organisation that is so friendly to alternative medicine that it has spent a billion dollars on research in the area, though it has produced not a single good treatment for that vast expenditure. But NCCAM too does not even mention Centella asiatica in its herb list. It does get a mention in Cochrane reviews but only as a cosmetic cream and as an unproven treatment for poor venous circulation in the legs.
What on earth is a “lymph remedy”. Just another marketing term?
“especially valuable in the treatment of breast, throat and uterus cancer.“
That is a very dramatic claim. It as as though the hapless students were being tutored in doublespeak. What is meant by “especially valuable in the treatment of”? Clearly a desperate patient would interpret those words as meaning that there was at least a chance of a cure. That would be a wicked deception because there isn’t the slightest reason to think it works. Once again there this wondrous cure is not even mentioned in either NELCAM or NCCAM. Phytolacca is mentioned, as Pokeweed, in Wikipedia but no claims are mentioned even there. And it isn’t mentioned in Cochrane reviews either. The dramatic claims are utterly unfounded.
Ah the mistletoe story, again.
NHS Evidence (NeLCAM) lists three completed assessments. One concludes that more research is needed. Another concludes that “Rigorous trials of mistletoe extracts fail to demonstrate efficacy of this therapy”, and the third says “The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak”.
NCCAM says of mistletoe
- More than 30 human studies using mistletoe to treat cancer have been done since the early 1960s, but major weaknesses in many of these have raised doubts about their findings (see Question 6).
- Very few bad side effects have been reported from the use of mistletoe extract, though mistletoe plants and berries are poisonous to humans (see Question 7).
- The U.S. Food and Drug Administration (FDA) has not approved mistletoe as a treatment for cancer or any other medical condition (see Question 8).
- The FDA does not allow injectable mistletoe to be imported, sold, or used except for clinical research (see Question 8).
Cochrane reviews lists several reviews of mistletoe with similar conclusions. For example “The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak”.
Anthroposophy is one of the highest grades of fantasy you can find. A post on that topic is in the works.
“Indicated for cancers . . . colon/rectal, uterine, breast, lung“. A cure for lung cancer? That, of course, depends on how you interpret the weasel words “indicated for”. Even Wikipedia makes no mention of any claims that Thuja benefits cancer. NHS Evidence (NeLCAM) doesn’t mention Thuja for any indication. Neither does NCCAM. Nor Cochrane reviews. That is not the impression the hapless students of this BSc lecture were given. In my view suggestions that you can cure lung cancer with this tree are just plain wicked.
Pure snake oil, and not even spelled correctly, Harry Hoxsey’s treatment centres in the USA were closed by court order in the 1950s.
At least this time it is stated that there is no hard evidence to support this brand of snake oil.
More unfounded claims when it says “treated successfully many cancer patients”. No references and no data to support the claim. It is utterly unfounded and claims to the contrary endanger the public.
Gerson therapy is one of the most notorious and unpleasant of the quack cancer treatments. The Gerson Institute is on San Diego, but their clinics are in Mexico and Hungary. It is illegal in the USA. According to the American Cancer Society you get “a strict low-salt, low-fat, vegetarian diet and drinking juice from about twenty pounds of fresh fruits and vegetables each day. One glass of juice is consumed each hour, thirteen times a day. In addition, patients are given several coffee enemas each day. Various supplements, such as potassium, vitamin B12, pancreatic enzymes, thyroid hormone, and liver extracts, are used to stimulate organ function, particularly of the liver and thyroid.”. At one time you also got several glasses of raw calf liver every day but after infections killed several people] carrot juice was given instead.
Cancer Research UK says “there is no evidence to show that Gerson therapy works as a cure for cancer”, and “The Gerson diet can cause some very serious side effects.” Nobody (except perhaps the Price of Wales) has any belief in this unpleasant, toxic and expensive folk-lore.
Again patients are endangered by teaching this sort of stuff.
And finally, the usual swipe at vaccines. It’s nothing to do with herbalism. but just about every alternative medicine advocate seems to subscribe to the anti-vaccination lobby.. It is almost as though they have an active preference for things that are known to be wrong. They seem to believe that medicine and science are part of an enormous conspiracy to kill everyone.
Perhaps this dangerous propaganda might have been ameliorated if the students had been shown this slide (from a talk by Melinda Wharton).
Click to enlarge
Left to people like this, we would still have smallpox, diphtheria. tetanus and rabies, Take a look at Vaccine-preventable diseases.
This is the sort of ‘education’ which the Pittilo report wants to make compulsory.
Smallpox in Baltimore, USA, 1939. This man was not vaccinated.
Conclusion
This selection of slides shows that much of the stuff taught in degrees in herbal medicine poses a real danger to public safety and to public health.
Pittilo’s idea that imposing this sort of miseducation will help safety is obviously and dangerously wrong. The Department of Health must reject the Pittilo recommendations on those grounds.
Follow-up
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I am completely shocked. To teach students dangerous nonsense is one thing – to teach them the weasel words to use in order to try to flout the law can only really be described as criminal.
A brilliant deconstruction as ever, David.
I wonder what “real science” unit courses these same students would have got? And did their heads start hurting from the “doublethink” necessary to keep it all in there at the same time?
I posted the following over on Jack of Kent’s blog, in response to something an osteopath (I think) had said. but it seems apt here:
————————————-
[Patients] should certainly be told honestly about the risk-benefit balance of ANY treatment. However, quacks repeatedly falsify this information by claiming their treatments have “proven benefits” (which they usually don’t) and “little or no risk” (which is also often a lie).
Unlike real doctors, most quacks do not have to take an oath to be honest with their patients. Most of them simply opt for being “honest” within a limited frame of reference, as in:
Of course, a lot of the time what they believe to be true is arrant nonsense.
———————————–
If my other half, who is an NHS doctor, routinely told her patients things that were flagrantly untrue, she would be in danger of being struck off, and would deserve to be.
Meanwhile, on the the other side of the reality fence….well, as lecanard says, to teach students of Alt.Reality specifically how to weasel around any kind of legal and ethical responsibility is either transparently deluded, or utterly despicable. Or both.
Staggered by the slide that teaches students how to weasel-word their way around the Cancer Act. Not sure if claiming to “treat the person not the disease” would cut much ice with Trading Standards – I certainly hope not. It’s illegal to advertise any offer to “treat any person for cancer, or to prescribe any remedy therefor, or to give any advice in connection with the treatment thereof”, but I’m not sure how this would be applied by TS officers dealing with someone who claimed not to be treating the cancer, but rather the person. If it’s not technically illegal, it’s certainly unethical and this does not show Westminster University in a good light at all.
[…] This post was Twitted by EmperorNorton […]
Is it not some sort of offence to encourage people to break the law? The intention/purpose of the Cancer Act seems to be to protect people from false claims, so if someone is encouraged to do something which contradicts the intention, then are they not doing something illegal? This is not the first time this has happened. The Quacktitioner Royal’s foundation had a similar encouragement at one time, but I think they took it down.
The question is how can we, in this instance, get this law upheld?
It’s debatable whether “we treat the patient, not the disease” would evade the Cancer Act. The proscribed actions are quite broad: “No person shall take any part in the publication of any advertisement …
containing an offer to treat any person for cancer, or to prescribe any remedy therefor, or to give any advice in connection with the treatment thereof”. They’d be hard out to advertise treatments for patients with cancer without including anything that could be classed as “advice”. Surely just advising cancer patients to seek herbal treatment would be “advice in connection with the treatment thereof”?
Of course Eli Jones may be correct in linking vaccinations with “the rise in cancer”: after all, people who have died healthy natural deaths as a result of smallpox, diphtheria or measles are unlikely to develop cancer.
I’ve been trying to find the figures for the UK corresponding to the ones in Melinda Wharton’s slide, but clearly I don’t know where to look. Can anyone help please?
@eveningperson
You could try these links for starters. I’ve not searched the site myself but have used Office of Population and Census in the past (pre-internet) for figs on disease prevalence, so it may give you some guidance.
http://www.statistics.gov.uk/STATBASE/Product.asp?vlnk=616
http://www.statistics.gov.uk/glance/
http://www.statistics.gov.uk/default.asp
[…] Anyone who harbours any inclination towards Chinese medicine should read this thorough demolition on DC Science: “Why degrees in Chinese medicine are a danger to patients“. […]
[…] sc_security=""; ← Simon Singh on chiropractic: “Beware the spinal trap” Why degrees in Chinese medicine are a danger to patients […]
Seems to me that anyone relying on “Traditional Chinese Medicine” should also arrange for a “Traditional Chinese Funeral.”
Yes, “Western Medicine” as they call it (I prefer to refer to it as “medicine”) may not be perfect, but I’d rather have “not perfect” as opposed to “dreadful.”
[…] Medicine myths in Universities: Prof. Colquhoun discusses some of the dangers of Chinese unscientific medicine with the help of some very entertaining […]
Excellent and frightening article.
But just one piece confused me:
‘the weasel words “indicated for”. ‘
That’s a common phrase in medicine and pharmacy. If you look up, for example, the British National Formulary, you will see the entries for each drug, and their indications. So a medicine is ‘indicated for’ a certain disease.
Anyhow keep up the great work.
Oh yes the term is common enough. I called them “weasel words” because it seems to me that to say “indicated for cancer . . .” is being used as a way of evading saying what you mean. It carries the suggestion that it benefits cancer, or even that it cures cancer, but without ever saying that. That seems to me to be fundamentally dishonest.
Yes… presumably they are using “indicated for” here in the way that the homeopaths deploy “{traditionally) used in the treatment of”.
Hence “Some culture has once used this as a folk remedy for… honest”
Of course, you might think that they were in fact relying on people inferring the usual medical / pharmacy meaning, “is given as an evidence-based treatment for” – rather than the weasel meaning – as a way to boost sales.
My original belief was that homeopaths & other CAM practitioners were just as honest and decent as the rest of the population. However, the more I see these “weasel words” the more cynical I become about them.
Dr Colquhoun’s article is misleading, full of weasel words and xenophobia.
To take slides from two lectures of a three year course is plainly unrepresentative. Of the two lectures chosen, one contains virtually no Traditional Chinese Medicine and the other is a year one foundation lecture referring to traditional metaphor translated from ancient Chinese, as the use of capitals, inverted commas and italics makes apparent to even the casual reader.
This is taken as ‘evidence’ that Traditional Chinese Medicine is dangerous to the public when it represents nothing of the sort.
Sloppiness in establishing an evidence base is not new in conventional circles. Level of evidence for the efficacy of conventional medicine is remarkably low, but somehow attempts to hold the high ground on EBM continue:
(2007) BMJ Survey: Of around 2500 (medical) treatments reviewed, 13% were rated as beneficial, 23% likely to be beneficial, 8% as trade off between benefits and harms, 6% unlikely to be beneficial, 4% likely to be ineffective or harmful, and 46%, the largest proportion, as unknown effectiveness.
http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp
Stefan
If the only problem is the modest number of pieces of teaching material that I have managed to find, that could be remedied easily if you would kindly send me the complete set of teaching materials from courses that he you have taken or taught yourself.
Talking of sloppiness, I’m surprised that you don’t cite also John Garrow’s letter in the BMJ concerning the reference that you give. He points out the one reason that the 46% figure is so high is that it included a large number of CAM treatments that are either ineffective or unknown. Of course it remains true that many treatments used in medicine have yet to be tested thoroughly, but the difference is that we are trying to weed out the ineffective ones, while you are not.
Your obvious familiarity with Westminster courses suggests that you might be Stefan Chmelik MSc MRCHM MBAcC MATCM MBHMA DipCHM LicOHM DipAc DipCHM (Dermatology) ClinAc (Nanjing) CST I/II. If so you certainly have a lot more letters after your name than I have, but some of the claims on your New Medicine Group site seem to me just a little bit dubious. Your claim to treat thyroid disorders with herbal medicine and moxibustion look to me to be potentially rather dangerous. Your claims about diabetes and about rheumatoid arthritis, and pneumonia are also potentially dangerous in my opinion.
Dr Colquhuon,
I do not and never have taught at Westminster University and my only familiarity with their course is the notes you appear to have taken out of context by abusing the Freedom of Information Act. Given this methodology, is it not somewhat obtuse of you to suggest that any institution would voluntarily subject their material to this form of scrutiny? You do not have a training in Chinese Medicine and can no more comment on concepts such as the San Jiao than a Homeopath can on limb reconstruction.
With reference to your other point, are you seriously proposing that the quantity of CAM services within the NHS in 2007 was sufficient to skew statistics?
Thank you for highlighting the diverse range of pathologies that are potentially treatable using traditional methods such as Chinese Medicine. You state that treating certain conditions with acupuncture, herbal medicine or moxibustion is dangerous, but I believe you are confusing lack of belief in efficacy with danger. I suspect many doctors would agree with some of the following statements:
Thyroid disorders – “Low thyroid is not a simply positive or negative diagnosis, but rather a scale of severity, which equals the level to which the overall health is affected.
An overactive thyroid is generally harder to treat than an under active one. However, there is still scope for treatment in cases where hospitalisation is not required.”
Pneumonia, bronchitis – “Where the symptoms have been going on for more than a month, another explanation should be sought. Your GP may send you for an X-ray or blood test to eliminate some of the possibilities, but if these do not provide an answer the usual recourse is antibiotics or anti-asthmatic medication.”
Rheumatoid arthritis – “This is a complex, difficult and destructive disease, with different causes, each of which must be clearly identified for treatment to be helpful. Whatever the direct cause, it is always wise to work with your immune system as this is an autoimmune disorder, and there are a number of tried and tested ways of doing that. Chinese Medicine successfully uses herbal formula for the immune system, diet can be an important factor and visualisation and meditation have been shown to have a beneficial effect. Acupuncture is helpful for joint pain”
Diabetes – “Early-onset (type 1) diabetes is hard to eliminate completely, but meaningful improvements in quality of life and long-term health prospects can be achieved. Adult onset (type 2) diabetes is much more to do with lifestyle, and can be completely altered with the right kind of advice and support.”
Stefan, the fact something’s translated from an ancient language doesn’t stop it being nonsense. You should try Herodotus. Nor does pointing it out make you a xenophobe. If Dr Colquhoun were a xenophobe he’d be attacking courses on the grounds they were Chinese-ness rather than nonsense or dishonest.
Or are you saying that your preference for Chinese medicine, rather than the Hippocratic corpus, is due to xenophobia against the Greeks?
Stefan
(1) Westminster – that was just a guess -you seemed to know which slides came from “a year one foundation lecture”. It is irrelevant anyway.
(2) Given the astonishing nature of what is taught, it doesn’t surprise me at all that institutions do their best to conceal these materials. I’d be ashamed of them too.
Since the taxpayer contributes to the cost of these courses, I think they have every right to know what is being taught on them. It is rather shameful that that such efforts are made to conceal them. I’ll happily send you any of my teaching materials that you want.
(3) You say
Actually homeopaths don’t hesitate to comment on limb reconstruction or anything else, including malara, AIDS and cholera, But arguments from authority carry very little weight, Anyone can comment on whatever they wish. It doesn’t take a great deal of knowledge to see that “marrow fills the brain” is grade one junk.
(4) You list the four conditions that I mentioned without even the slightest attempt to provide any evidence that moxibustion, or Chinese herbs, can benefit them. Evidence really does matter when you are treating people who are ill. Since all of the conditions can be treated more or less effectively by medicine, the main danger lies, as with homeopaths, in the possibility that patients who are really ill will be distracted from seeking proper treatment that works. Recall that homeopaths were recently convicted of manslaughter in Australia after their own daughter died as a result of not being given proper treatment, It can only be a matter of time until the same happens to a practitioner of traditional Chinese medicine (TCM). TCM is at least as dangerous as homeopathy. It is much the same in cases where the herbs are inactive, and potentially more dangerous when active compounds are given in unknown doses.
Professor Colquhuon,
I have seen some of your teaching notes and I imagine you are an excellent researcher, but researchers perhaps need to be careful about commenting on clinical matters. The fact is that patients vote with their feet, and 15-20% of the UK population consult CAM therapists. In addition, unlike the rumours that suggest you are a pharmaceutical company stooge, i suspect you simply have too much time on your hands since the, extremely sad, closure of the UCL Pharmacology Dept and the loss of your Chair.
You say “Traditional Chinese Medicine is at least as dangerous as homeopathy”. This is nonsense. It is much more dangerous. Only inert treatments with no potential for benefit also have no potential for harm, and the fact is that the majority of the world’s population makes its own risk-benefit judgment to use their traditional medical systems and have done so for several thousands of years, without significant proportions of the population keeling over as a direct result. Unlike conventional medicine in the UK and USA, traditional medicine IS NOT the third or fourth main cause of death in its countries of origin. To pull a quote from your own website Reporter: “What do you think of Western Civilisation?” Gandhi: “It would be a good idea”. It would seem, in fact, that you accept that western science and civilization are not as good as they believe they are, which leaves me somewhat confused as to the motivation behind your attempts to discredit CAM therapies.
@ Stefan
People also vote with their feet in large numbers when they go to visit Lourdes. This cannot be taken to imply that going to Lourdes actually works.
People have also prayed about their aliments to various gods “for several thousands of years”; again, this is hardly a knock-down argument for the proposition that prayer really works.
Conventional medicine is increasingly subjected to stringent analyses that allow us say with a grat deal of confidence what the risks and benefits are. Sadly the same cannot be said for “Traditional Chinese Medicine”.
Since “Traditional Chinese Medicine” (unlike say homeopathy) actually contains ingredients, it is, of course, perfectly possible that some of these substances actually work and actually do more good than harm (even if the proposed mechanism of action is complete nonsense). But before anyone uses these “traditional” remedies, (and certainly before anyone teaches others to promote these remedies) I think it might be a good idea to find out whether they do actually work and actually do more good than harm by conducting a few randomized controlled trials.
The problem, as ever with so called “CAM”, is that if any of these remedies were shown to work, they would cease to be “Traditional Chinese Medicine” and would become simply “medicine”.
Stefan said: “The fact is that patients vote with their feet, and 15-20% of the UK population consult CAM therapists.”
Are you seriously proposing that as a reason why it should be reverentially and uncritically studied at a supposed institute of higher education?
Stefan, The reasons why anyone spends a second of their time exposing and protesting against quack therapies is because they don’t work and they leech resources from evidence-based treatment that do work.
Hope that helps.
With regards to your comments on Chinese medicine, i see no research findings to back up your comments, you can take any information out of context you can make it appear any which way you desire to, in this instance, you have presented your opinions and nothing that is evidence based.
Stefan,
there is nothing xenophobia. I am from China. Even in China, Traditional Chinese Medicine (TCM) has been debated for several decades, and a lot of scholars are criticizing Ministry of Health’s polices supporting TCM. You can find several thousand papers on the site http://xys.org/dajia/zhongyi.html , revealing numerous cases how TCM cheat in China.
Here are some posts summarized in English.
http://fangzhouzi-xys.blogspot.com/search/label/traditional%20Chinese%20medicine
@Amsel
Tnanks very much for that fascinating link, It is very heartening to hear that the critical spirit is alive and well in China. Ever since
Vickers et al. (1998) found that “No trial published in China or Russia/USSR found a test treatment to be ineffective”, there has been a deep suspicion about results for TCM that have been reported from China. No doubt the Chinese. like everyone else, want the most effective treatments they can get. Recall that Mao Tse-Tung himself is reported to have said
@Stefan
All we are asking for is some evidence that the treatments that you advocate actually work. It seems a simple question but thus far you haven’t produced any evidence.
I’m glad you like the Gandhi quotation. The original reason for posting it was that I felt that evidence had been distorted, and invented. in the run up to the Iraq war. That seems to me to be an illustration of the harm that can be done when you mistake wishful thing for truth. That’s exactly what a lot of practitioners of alternative medicine do too.
You speak of my “attemots to discredit CAM therapies”, but that isn’t actually what I’m trying to do. I merely have an interest in evidence, and in how one achieves the (remarkably difficult) feat of distinguishing which treatments work and which don’t. I’m every bit as interested in that question in pharmacology as in CAM. All I ask is that the same standards be applied to both. At present that is not the case. CAM is not required to produce evidence of efficacy in the same way that the rest of us are. I can see no good reason for this double standard.
Stefan
It is best to concentrate on the evidence – i am sure good RCT trial evidence and so forth would be the most effective way of persuading DC, skepticat and Zeno that you are correct.
The comments in the last sentence at the end of #23 aren’t at all helpful. 2+2=4 and 2+2does not = 4 irrespective of the amount freetime we have on our hands.
Professor Colquhoun,
1. You have asked for evidence, so I have provided some via this weblink:
Click to access tcm_evidence.pdf
In addition, the NICE response (cited in the link) to acupuncture for low back pain is encouraging. As always ‘absence of evidence is not the same as evidence of absence’ (which is where patients voting with their feet comes in – they are prepared to believe the evidence of their own experience). Without the backing of the pharmaceutical industry and the support of the NHS it is more or less impossible to get the funding and recruitment to do large-scale clinical trials, but this you all already know.
However, my experience is that some people, lets call them Flat Earthers, are quite capable of ignoring evidence that does not sit comfortably with their world-view. We shall see.
2. Spellbound, with regard to your comment below, I am unclear whether you are referring to my own or Prof C’s comments, please clarify.
Spellbound wrote:
“With regards to your comments on Chinese medicine, i see no research findings to back up your comments, you can take any information out of context you can make it appear any which way you desire to, in this instance, you have presented your opinions and nothing that is evidence based.”
3. Schroedinger99 wrote:
The problem… is that if any of these remedies were shown to work, they would cease to be “Traditional Chinese Medicine” and would become simply “medicine”.
This denies that the real debate here is about world-view, that of traditional Greco-Roman based science vs traditional Asian based science. In reality, the people pushing the boundaries of high-level physics increasingly produce findings that are more consistent with the Asian view than the Greco-Roman one. Within the context of high physics, there is nothing especially revolutionary about the concept, say, that Homeopathic remedies contain none of the original substance from which they were originally derived.
4. Skepticat:
“Stefan, The reasons why anyone spends a second of their time exposing and protesting against quack therapies is because they don’t work and they leech resources from evidence-based treatment that do work”
As there is close to zero CAM provision within the NHS, any notion of ‘leeching’ is nonsense. As the BMJ article on clinical evidence I have already cited points out, the evidence base for conventional treatments is actually rather poor. The link above points to evidence of efficacy for certain CAM therapies.
5. Amsel: wrote
“Even in China, Traditional Chinese Medicine (TCM) has been debated for several decades”.
Actually, Chinese Medicine has been subject to written critical debate and ongoing revision for several thousand years, making it the most empirical system of medicine available. Also, TCM has been credited with saving Mao’s life, which is why he reversed his previously stated objective of eradicating it.
6. Colquhoun wrote:
“CAM is not required to produce evidence of efficacy in the same way that the rest of us are. I can see no good reason for this double standard.”
The ‘good reason’ of course is that statutory regulation is taking so long, which is the only thing that will provide the methodology you claim to seek. Yet you specifically oppose the Pittilo Report and regulation, making your statements contradictory.
Imagine a classical physicist in 1898, suddenly finding out aspects of modern sub-atomic theory. Not only would the worldview of modern quantum mechanics be entirely foreign to him, counterintuitive, indeed outlandish and bordering on the insane, but so too would the classical physicist be unable to understand the experimental observations, for example at CERN, because observation relates to theory, and the classical physicist would be lacking that theory.
Imagine beyond this that both the classical physicist, and modern physicist, both accepted the principle of the scientific method, and were agreed that the way forward was to adopt an open minded view, in which the atomic physicist would patiently try to persuade the classical physicist that quantum physics and other modern physics made sense. What would be required?
Firstly, the modern physicist would have to ensure that the classical physicist understood the theory of modern physics, because experimentation cannot be performed or understood correctly unless the underlying theory is also understood. So, initially, the classical physicist would have to master about 110 years worth of new theory. However, once this was accomplished, the classical physicist would have every right to examine, and rigorously test, all experimental evidence used to support modern physics theory.
I think any scientist would agree that the above procedure is entirely reasonable, and scientific.
Now consider a somewhat different, but in many ways parallel, scenario. The classical physicist becomes a modern medical doctor, steeped in modern medical science. The atomic physicist becomes an expert traditional Chinese medicine doctor (I don’t mean to imply here that their respective positions are strictly comparable to those between a 19th century physicist and a modern physicist – my point is simply that the two disciplines are profoundly different in crucial assumptions about the nature of reality). The traditional Chinese medicine doctor would have to say, before you can begin to appreciate how to scientifically evaluate traditional Chinese medicine (TCM), you must first understand the theory in depth, because the experiments must accurately represent the theory.
Once again, I think that any open minded scientist would accept that this procedure is entirely reasonable. If this isn’t reasonable, how much more unreasonable would it be to expect a classical physicist to accept the postulates of quantum mechanics, that even as great a physicist as Richard Feynman accepted seem beyond being understandable?
Now the problem, and this point must be stressed, is that when one carefully looks at the current scientific evidence pertaining to TCM, this process of matching the theory of TCM to experimentation simply hasn’t been done rigorously, and hence the results are inconclusive. Many studies in China, and perhaps most, have not been done with the rigour to satisfy the scrutiny of most Western experts in clinical research. Conversely, studies done in the West have almost entirely been based on protocols which do not accurately represent correct TCM clinical practice. This is the case for several reasons: correct TCM practice always starts from a very intricate and detailed diagnosis, and therapeutics proceed from the diagnosis. Fifty patients with one condition from a modern medical point of view may have different conditions from the perspective of TCM, and if these differences are not carefully matched by therapeutics, one simply is not testing TCM, but instead a crude and inaccurate representation of it, so that little is learned about TCM itself.
What conclusions can we draw from this? If we insist that medical practice must be based on rigorous clinical trials, we can discard TCM on the basis that rigorous evidence for its efficacy doesn’t exist. That is certainly one approach. There are people who do believe that this is the right thing to do, and I think their number includes participants in this forum.
However, we can see several profound objections to such a draconian solution. Firstly, a considerable amount of conventional medical practice is not based on rigorous clinical evidence of efficacy. So, to target TCM exclusively would be unfair in principle. Secondly, given that TCM has had extensive use over many years, perhaps it actually does have something of genuine value, at least in empirical techniques. After all, the Chinese discovered smallpox inoculation before it was discovered in the West. Do we want to throw away the medicine of an advanced culture merely because it has not yet been subjected to proper clinical evaluation? Thirdly, there is freedom of choice in the medical arena: even if some people think TCM should be suppressed, there are many others in the West who find it valuable for themselves. Do they have a right to use it?
The main point I wish to emphasise, however, is that at this moment, we are very far away from anything of a fully valid clinical evaluation of TCM that both accurately represents how it is correctly practised, and which is also rigorous from a modern scientific perspective. This uncertainty affects just about every facet of TCM practice. There has been no systematic attempt to put to the scientific test the core concepts of TCM, so we simply don’t know what validity concepts such as Spleen Yang deficiency, and just about all others (and there are many) have in clinical practice, on the basis of experimental testing. The absence of scientific evaluation of those concepts is not the same thing as those concepts being invalid: it is not that scientific evaluation has determined that TCM concepts are invalid.
@Niels
OK let’s stay calm. But I’ll admit that I do find it really a bit offensive that an apologist for TCM should adopt the name of one of the great physicists of the 20th century, and cast him/herself as the great revolutionary rather than the conservative. Hoemopaths seem particularly fond of invoking quantum theory, despite the fact that most couldn’t even differentiate ex. What would people think if I adopted the nickname Einstein? I’d be laughed out of court, and rightly so. But let’s look at your arguments anyway.
The conclusion of your argument seems to be much what we’ve all been saying. The evidence just isn’t there. But you don’t carry your argument to its logical conclusion. It seems to me to be irresponsible and dangerous to sell to sick people treatments with unknown efficacy and often unknown safety. I can see no earthly reason why TCM should be exempted from the same rules as apply to any other medicine. But it is and what you say does nothing to defend this anomaly.
I’m not sure what you mean by “suppressing” TCM. I don’t know of anyone who wants to make it illegal. I’m happy to regard it as a voluntary self-imposed tax on the gullible. But TCM practitioners are, of course, subject to the laws of the land like anyone else, so if they break those laws they must expect, like anyone else, to find themselves in court. It certainly isn’t inconceivable that a charge of manslaughter could occur here, as it has in Australia. And should have thought that much of TCM as practised on the High Street must break Unfair Trading laws, but that is yet to be decided because the laws are quite recent.
Your last statement just reiterates the constant mantra of all alternative medicine advocates “absence of evidence is not the same as evidence of absence” (see it said live at Integrative Baloney @ Yale, on Youtube. It is true, of course, but utterly unhelpful. I imagine that since you model your role on that of a modern physicist, you’ll be quite familiar with the idea of the power of a hypothesis test, so I’m surprised that you should think it worth mentioning. I’ll be happy to try to explain in more detail if you wish. In any case some negative results are now quite well-established, for example the indistinguishablity of ‘real’ and sham acupuncture (and hence the nonsense of ‘meridians’.
@ David Colquhoun
David,
Firstly, let me assure you that I probably admire Niels Bohr, and for that matter a number of great scientists including of the classical physics variety, every bit as much as you do. Richard Dawkins is, indeed, one of my favorite authors. So, I refuse to be drawn into a ‘them and us’ type of argumentation. My pen name in this forum carries a hint of irony, but it is respectful.
You fail to acknowledge the central point of my posting above, which is that the fully proper scientific way of dealing with ideas that fall outside the mainstream is not to hurl invective against them, but to subject them to scientific scrutiny, utilizing the scientific method. Until that is done, one can’t dismiss those unorthodox positions rigorously, and there are cases in the history of science when new ideas which eventually won the day probably seemed even more preposterous than the tenets of traditional Chinese medicine seem to many doctors now.
You wrote:
“The conclusion of your argument seems to be much what we’ve all been saying. The evidence just isn’t there. But you don’t carry your argument to its logical conclusion. It seems to me to be irresponsible and dangerous to sell to sick people treatments with unknown efficacy and often unknown safety. I can see no earthly reason why TCM should be exempted from the same rules as apply to any other medicine. But it is and what you say does nothing to defend this anomaly.”
I would like to answer you in depth.
DC: “The conclusion of your argument seems to be much what we’ve all been saying. The evidence just isn’t there.”
‘The evidence’, in the form of rigorously conducted clinical trials that reflect proper TCM practice, is not there, at least for the overwhelming majority of conditions that TCM treats. I think we are in basic agreement about this point. There are, however, different types of ‘evidence’. Classical Chinese medicine was a highly developed system in which very careful observation was employed, in respect of both diagnosis and therapeutics. As I think you know, the malaria drug Artemisan was developed from, I believe, 8th Century CE Chinese medical documents that described what modern Chinese scientists recognized as a description of the symptoms of malaria, along with treatment which was, apparently, effective, using the Chinese herb Qing Hao. There are similar examples of this matching of observation and therapeutics; for example, the Chinese had discovered that pig’s pancreas can be used to treat a disease that we can recognize as Type 1 diabetes. I don’t think that any reasonable person could assert that the Chinese never discovered anything of medical value.
However, where things get interesting is that Chinese medicine was much more sophisticated than in just in matching individual nature-based medicines with individual medical conditions. (We acknowledge in the West that ‘primitive cultures’ may have made such discoveries, of genuine value to us, for example in the Amazon.) The Chinese went well beyond that level of medical knowledge to develop very complex methods of diagnosis and therapeutics associated with that diagnosis. Almost inevitably, Chinese medical concepts differ from modern scientific ones. That is entirely to be expected. Cultures tend to be unique, and to frame things theoretically in different ways. But that doesn’t mean that Chinese medical knowledge was primitive. I hope you acknowledge at least a theoretical possibility that in over two millennia of systematic development of medicine, the Chinese achieved something of value, beyond treatments such as Qing Hao for malaria.
DC: “It seems to me to be irresponsible and dangerous to sell to sick people treatments with unknown efficacy and often unknown safety.”
If I went outside and picked a leaf off a tree haphazardly, and then told someone with AIDS to take it, and to give up their conventional drug treatment, that would be completely irresponsible. However, proper Chinese medicine practitioners don’t do things like that. In the West, but also in the PRC, treatments are administered with great care and respect for what is available from conventional medicine, which I will subsequently called ‘biomedicine’.
If Chinese medicine continues to be taught in universities, you can be absolutely sure that Chinese medicine practitioners will provide very careful advice to patients, respecting and factoring in what biomedicine offers. If, on the other hand, Chinese medicine is driven underground, then it is also likely that standards and the level of knowledge of practitioners will deteriorate, so that patients will be more endangered along the lines you fear. It is actively in the interests of public safety for Chinese medicine to be taught in a university setting. The same goes for the state regulation of practitioners. Being driven underground tends to make people less accountable, less responsible, as well as less educated.
DC: “I can see no earthly reason why TCM should be exempted from the same rules as apply to any other medicine. But it is and what you say does nothing to defend this anomaly.”
The constant refrain one hears amongst Chinese medicine practitioners, who are intent on clinical research, and there are many, is how difficult it is to get funding. As you know, a discipline like acupuncture is never going to generate the revenue to make the sort of research that is used to develop pharmaceutical drugs affordable. But individuals such as yourself could help, by encouraging the authorities to invest more in the type of research that would more satisfactorily answer the questions that you and many others have.
@Stefan “This denies that the real debate here is about world-view, that of traditional Greco-Roman based science vs traditional Asian based science.”
Umm. No. Modern science is not really Greco-Roman based in terms of theory. The kerfuffle over Galileo was that he started introducing things like experiments and empirical evidence contrary to Aristotle. Medics might like the idea of reciting the Hippocratic oath, but aside from linguistic terms there’s not a lot Greco-Roman in modern medicine. The Hippocratic corpus is mainly a catalogue of ways people could die. There is bigger impact from the Greco-Roman past is in the mathematical sciences, but even there modern scientists ignore things like what Pythagoras said about beans.
@Niels, you seem to have skipped an important part of the scientific process. Any researcher discovering quantum mechanics and publishing it would be expected to be able to show that he was also familiar with classical physics, before having his work taken seriously. That’s not just medicine or physics, it’s academia in general. Even if you think Prof. X’s work is lunacy, if you’re publishing research in a field where Prof X’s is well-known, your research paper would be expected to refer to his work. Even if it’s just to say it’s wrong (or doesn’t apply in this case if you want to be diplomatic). It’s a matter of demonstrating basic competence. A homeopath citing a quantum memory of water might want to explain why the chaotic formation and destruction of ions in water isn’t an issue otherwise someone might (mistakenly) think the homeopath thought the water was simple H2O at the molecular scale.
So in the case of Stefan, we have someone who doesn’t understand what xenophobia means, and doesn’t understand the “Greco-Roman science” he cites. If he doesn’t understand what he’s criticising, how can he, or the rest of us, know if he’s right?
If you’re interested in Galileo and the rejection of Greco-Roman natural philosophy then you might be interested in Galileo: A Very Short Introduction by Stilman Drake. There’s a lot more to it the development of science than ‘the Catholics were the bad guys.’
@Niels
You seem to be a lot more impressed by ancient wisdom than I am. Certainly Chinese, and others, stumbled on a few good things (I think you’ll find the spelling is artemesin/ artemesinin by the way). You say
but you neglect to say that most of these “very complex methods” have turned out to be pure hokum. That doesn’t mean they were stupid. They were doing the best that they could at the time. But things have moved on since then, and to continue to advocate these ancient mistakes is about as sensible as having a degree in flat earth studies.
How you can maintain that in the light of the slides I have shown simply beats me. The slides show that students are being taught things that are demonstrably wrong and dangerous. The regulation that is proposed will be entirely ineffective in ensuring that the public are protected, which, of course, is why most herbalists etc want it. They get the stamp of respectability while beng able to continue to sell fairy stories with impunity.
As I have pointed out many times, NCCAM has spent of a billion dollars on research in CAM. Acupuncture is the clearest case. It has been throughly tested and it has failed. But the industry is not interested in tests that might reduce its income. The alternative medicine business is huge -something like 60 billion dollars a year. One only conclude that the reason so little testing is done is not shortage of money but fear that tests would be failed.
@Alun
Alun,
You wrote:
“@Niels, you seem to have skipped an important part of the scientific process. Any researcher discovering quantum mechanics and publishing it would be expected to be able to show that he was also familiar with classical physics, before having his work taken seriously. That’s not just medicine or physics, it’s academia in general. Even if you think Prof. X’s work is lunacy, if you’re publishing research in a field where Prof X’s is well-known, your research paper would be expected to refer to his work. Even if it’s just to say it’s wrong (or doesn’t apply in this case if you want to be diplomatic). It’s a matter of demonstrating basic competence. A homeopath citing a quantum memory of water might want to explain why the chaotic formation and destruction of ions in water isn’t an issue otherwise someone might (mistakenly) think the homeopath thought the water was simple H2O at the molecular scale.”
Again, answering in depth:
Alun: “@Niels, you seem to have skipped an important part of the scientific process. Any researcher discovering quantum mechanics and publishing it would be expected to be able to show that he was also familiar with classical physics, before having his work taken seriously.”
I’ve never denied that. In my example, I did not suggest that a modern physicist should not be acquainted with classical physics. Nor have I argued that someone researching TCM should not understand biomedicine. However, and possibly in direct agreement with your point, I have argued, and believe that it is necessary, that a researcher investigating traditional Chinese medicine should have expert knowledge of that field, in order to be able to design clinical trials in a manner that accurately represents Chinese medicine practice.
Therefore, to take your point further, when researchers are not genuinely expert in Chinese medicine – and this is often the case with Western researchers – their research lacks value, precisely because they didn’t have the requisite expertise in Chinese medicine, and therefore designed protocols that were fallacious from a Chinese medical point of view. As a consequence, they may be researching some version of acupuncture, but not acupuncture corresponding to proper Chinese medical practice.
I’d like to provide a counter example. Imagine traditional Chinese medicine researchers with only very limited knowledge of modern conventional medicine researching the use of a specific antibiotic to treat, for example, urinary tract infections. In their ignorance, they might not realize that good medicine requires that a urine culture be taken, and the drug chosen in correspondence to the particular micro-organism involved, so they treat every patient with exactly the same antibiotic. Also in their ignorance, they don’t represent their research as merely research into that one antibiotic, but instead they generalize their study to the totality of conventional medical practice, and call their study ‘The efficacy of conventional medical drug treatment in treating UTIs” Obviously, in that case, the results will be skewed, and will certainly not represent best practice, and not even good practice. Research like that would be research of a kind, but of a very poor kind, and it is unlikely that any medical doctor would take it seriously. Yet Chinese medicine practitioners are constantly subjected to something similar to this in the West.
There are many Chinese medical practitioners in the West who are dedicated to the ideal of rigorous research, who are extremely keen to put this right, but the infrastructure of research, including funding, is not conducive to this.
Alun: “A homeopath citing a quantum memory of water might want to explain why the chaotic formation and destruction of ions in water isn’t an issue otherwise someone might (mistakenly) think the homeopath thought the water was simple H2O at the molecular scale.”
This particular thread is essentially devoted to Chinese medicine, and I will restrict my comments to Chinese medicine, and not to other health modalities such as homeopathy or Western herbal medicine.
@ David Colquhoun
You wrote:
“You say
” . . . develop very complex methods of diagnosis and therapeutics associated with that diagnosis”
but you neglect to say that most of these “very complex methods” have turned out to be pure hokum. That doesn’t mean they were stupid. They were doing the best that they could at the time. But things have moved on since then, and to continue to advocate these ancient mistakes is about as sensible as having a degree in flat earth studies.”
I’m glad that you accept that at least the Chinese weren’t stupid. The next question is whether their ‘“very complex methods” have turned out to be pure hokum.’ That is where I don’t think you have a case. If we accept the use of scientific method to try to resolve this issue, we must employ experimentation that is tailored to rigorously resolve the questions. This means that one has to submit the theories and therapeutics to a rigorously painstaking and detailed investigation. If you know of this work having been done, I’d be very excited, and I would be delighted to have a look at it. However, to my knowledge, this work hasn’t been done.
You wrote:
“How you can maintain that in the light of the slides I have shown simply beats me. The slides show that students are being taught things that are demonstrably wrong and dangerous. The regulation that is proposed will be entirely ineffective in ensuring that the public are protected, which, of course, is why most herbalists etc want it. They get the stamp of respectability while being able to continue to sell fairy stories with impunity.”
I acknowledge that the Pitillo Report does consider forms of herbalism other than Chinese. The examples you provided above were associated with Western herbalism, and not Chinese. I don’t wish to comment on fields outside my direct expertise, and I will restrict myself to speaking about Chinese medicine. As you probably know, this is an area that the Chinese have put a lot of energy into developing since the communists took power. It is extremely common in China to use traditional Chinese medicine alongside Western medical treatment. I don’t know a single CM practitioner in the UK who would interfere with a cancer patient having conventional treatment. I have read that in the US, acupuncture is the most widely used CAM modality for providing treatment supplementary to conventional medical treatment, and that it is available in (conventional medicine) clinics. It is also the case that there are conventional cancer treatment units in the UK that employ acupuncture as a supplementary treatment to help cancer patients. There are cancer specialists who actively encourage such use of acupuncture, and many (probably most, I imagine) who tolerate it if that is what the patient wants. Chinese herbs are not, to my knowledge, widely employed in the biomedical care of cancer, in the US or UK, and possibly for very good reasons, patients are discouraged from mixing herbs with chemotherapy because of the possibility of adverse interactions. In every case I’ve known about, people with cancer who have received CM have informed their doctors, including oncologists, about it, and it only makes sense to do so. This is not some covert activity conducted in dark alleyways.
If, however, one tries to suppress Chinese medicine in various ways, by denigrating it, or by trying to prevent it being taught in universities, or by working against it being researched, the main consequence will be to push it underground, as I mentioned before. Patients will be reluctant to tell their doctors that they are having Chinese medicine. When CM is taught in a university context, it must satisfy certain criteria of quality. I personally think that much more conventional medicine should be taught in Chinese medicine courses, and I am very sure that this will be the way that education in Chinese medicine unfolds in the UK, as long as CM continues to be taught in universities. So, university teaching of Chinese medicine should be seen as a developing process, one in which the education standards of practitioners will continue to be raised. This is something that will directly protect the public. However, if the university education of CM practitioners is suppressed or terminated, the trainings will almost inevitably become much worse. The resources to teach science and biomedicine will become greatly attenuated, and we will end up with much more poorly trained CM practitioners, who are much less likely to be able to make the best informed decisions based on a knowledge of, and appreciation of, science and biomedicine.
Exactly the same consideration applies to State Registration. You are concerned that both university education and state registration will confer upon Chinese medicine some sort of validation, which will set loose upon the public a group of rogues who have no interest in trying to act in the best interests of their patients. I acknowledge that both state registration and university education confer a certain amount of status, but this is actually very limited. In actuality, what is much more likely is that rising educational standards in universities, coupled with state registration, will force the CM profession to be much better educated all round, benefiting from much better training in science and conventional medicine. The public will be much better protected, particularly with the cohort of vigilantes monitoring what Chinese medicine practitioners are up to, and making complaints to the HPC!
Essentially, a form of medicine that has gone underground is one that is much less safe than one that is conducted out in the open, under full scrutiny, with high standards being applied.
@Niels
I don’t think you have read what I said about “suppression”.
Really you are hoist by your own petard. You admit that that is very little evidence about whether Chinese herbal medicine works or is safe. In the case of acupuncture there is quite good evidence that it doesn’t work to any useful extent.
You can’t base degrees on subjects for which there is next to no evidence bacause that leaves you with next to nothing to teach. As I have shown, in practice the deficit is filled by teaching made up and untrue stuff like “marrow fills the brain”.
Luckily universities have realised that this is just not good enough and are closing the courses. It seems that your special pleading has come too late.
Again, here is some evidence as requested:
Click to access tcm_evidence.pdf
For those interested in learning about the legacy western science owes to the Chinese, you are referred to Joseph Needham’s (CH FRS FBA, 1900-1995) seven volume Science and Civilisation in China series. A further nine volumes are in preparation I believe:
http://www.nri.org.uk/science.html
@ David Colquhoun
David,
I’m afraid that you don’t bother to read what I’m saying about evidence. I won’t repeat myself, but would ask that anyone else reading this thread looks back, and considers these matters carefully.
Your comments suggest that you don’t understand Chinese medicine. Admittedly, it is difficult to, because it requires several years of intense training to see how the various concepts interrelate, as is the case for many disciplines. This is one of the reasons why, at the beginning of my comments, I emphasized that it was necessary for a researcher understand Chinese medicine thoroughly as a pre-requisite to evaluating it. I’m not suggesting that the researcher should necessarily ‘believe in’ Chinese medicine, merely that he/she needs to have a fully professional level of knowledge of it to proceed to the next step.
Without this knowledge, one is not in a position to interpret the meaning of discrete concepts. To take an example, you write:
‘As I have shown, in practice the deficit is filled by teaching made up and untrue stuff like “marrow fills the brain”.’
There’s not a single Chinese medicine practitioner who believes that bone marrow and the brain are identical in the sense you assume. That isn’t even said in Chinese medicine, where the brain is considered to have distinctly different characteristics from the bone marrow. What this comment is referring to is related to other concepts. I believe that it would take several years of intensive training in Chinese medicine to begin to understand how these concepts interrelate, just as in Einsteinian theory of gravitation, it is difficult to understand what is meant by space-time being curved. An untrained person who had read a lot of popular books on relativity might have a vague inkling of what curved space-time meant, but a professional physicist would not give that interpretation much time or space, because a professional understanding of the curvature of space-time is specific, and requires a detailed and exact knowledge of physics to be properly understood.
If one starts mapping modern scientific concepts onto jargon terms employed in Chinese medicine, the results are going to appear to be confused and, quite frankly, ridiculous. It is then easy to ridicule the outcome. But that is sloppy thinking, and certainly not a valid basis for advocating educational or regulatory policy.
@Stefan
I’ve got your tcm_evidence document and I’ll go through it as time allows. A first glance shows that it is not a systematic review, and that it cherry-picks the evidence, but nonetheless there might be something of interest. But I see that the conclusion of your document is “More research data is needed on the risks and benefits of Chinese herbal medicine”. So on that we agree. Where we differ is that I maintain that it is irresponsible to treat patients, or to run degrees, until after the evidence is obtain. What if the evidence turns out to be negative (as it has in the case of acupuncture)?
@Niels
I do wish you wouldn’t keep comparing ancient Chinese ideas with Einstein. It is desperately pretentious and leads nowhere. You keep on insisting that it takes years of study to "understand" slides such as those I have shown. An equally plausible interpretation would be that years of studying things that, in the 21st century, make no sense, numbs the brain to the distinction between truth and myth.
Robert Park, a real physicist, pointed out
Until such time as evidence is forthcoming, I see no reason why anyone should believe that you are right.
Incidentally I was intrigued to see that 1467 (as of today) herbalists have signed a petition opposing the (pseudo)-regulation which you support. Internecine strife is characteristic of quasi-religious organisations. It is the same with chiropractors.
@Niels
The lack of logic in this thinking is staggering and amounts to nothing more than the usual ‘you don’t understand us’ answer that appears with depressing frequency on these pages.
I don’t understand the minute details of DC’s work ion channels, nor do I know much about, say, plant physiology. But if I chose to read up about these things, there would almost certainly be some writings that would be pretty understandable at least to gain a modicum of knowledge.
But you seem to be telling us that it is not possible to understand TCM from lecture slides from a university, in which case how on earth are the poor students supposed to learn?
Now I may be quite wrong but the slides on this page seem pretty straighforward in what they say. Take for example “SJ assists the Lungs [sic] ‘dispersing function’ spreading fluids to skin in form of fine mist or vapour…” and the suggestion that the gall bladder is curious because it stores bile and that it is somehow involved in making judgements or decisions. This is akin to Galenic theory of humours which has long been superseded. It is pretty clear from what we now know that the gall bladder is not involved in judgements and decisions: otherwise how would people make decisions if they have had gall bladder removed? Nor do the lungs spread fine mists and vapours. This is just primitive and unrealistic stuff, dished up as something ‘traditional’ with the implication that it is therefore good. Many other arguments against TCM have been far better articulated here and elsewhere and I haven’t the time or energy to go through all the points you try to make. Of course I have no problem with people having beliefs as long as they do no harm to anyone and they do not pretend to be something that they are not. Proponents of TCM have yet to convince me that they understand the importance of truth, safety and of being grounded in reality, and no amount of regulation of discredited ideas will protect the public from the potential dangers of unproven remedies and therapies.
*applauds Lindy*
(Disclaimer: I’m a mathematician, not a physicist, but I know some physics and some physicists.)
I perceive a vast difference between TCM and the ideas of modern physics.
Obscurantist behaviour comparable to that shown by Niels would be unimaginable among physicists. If you publicly call out a physicist, claiming that the statement “spacetime is curved” is meaningless, the reply would simply not consist of the words “Oh, it means something, but it just can’t be understood without a fully professional understanding of physics”.
If the physicist is feeling uninspired or was an awful teacher, he could simply recite the definition of general relativistic spacetime: it’s a pseudo-Riemannian manifold with signature (+1,+1,+1,-1). Now that’s not much help, perhaps, but if you keep pushing by asking “What’s a manifold? What does it mean for a manifold to be pseudo-Riemannian? What’s the signature of such a thing? And how does this all mean it’s ‘curved’ anyway?”, you’ll soon enough get down to basics that you can agree on.
A more inspired and educationally competent physicist could draw pictures, make analogies, pad out the definition with sketches and motivational hints, making the process faster and much more enlightening.
Not that it matters, but in the past I have completely explained the definition of a manifold (which is the really important bit of the above) to an intelligent 18-year-old over a few cups of tea.
Nobody can doubt that the basic objects of modern mathematical physics are meaningful: the meanings are placed prominently on display. They’re lectured to undergraduates by lecturers who are happy to disperse their notes far and wide, and are have been made accessible to the layman by a series of excellent no-nonsense writers (including Simon Singh… there’s some irony lurking here somewhere).
And in case it’s important, the theory of curved spacetime has been subjected to the most rigorous tests, and have found been to describe reality to degrees of accuracy that are completely out of reach to medical experimentation (simply because there’s not enough people out there to experiment on!).
On the other hand, all I’ve ever seen from TCM people and alternative medicine people in general is bold claims backed up with evasion.
@James Cranch
James,
Richard Feynman pointed out – I believe in ‘The Nature of Physical Law’ – that physics explanations for laymen are always inadequate. (I could find this passage if I had to, but I don’t want to have to hunt through my books, particularly if it was in another of his books.) You can get somewhere with them, but then it breaks down because one needs the specific mathematics to convey the ideas properly.
I accept that one could provide something of a vague explanation of various ideas in physics to laypeople, over a few cups of tea, but I’m sure you know as well as I do that these explanations would be vague, and in stark contrast to the precise understanding of a professionally trained physicist. As a mathematician, you can’t tell me that the material on the webpage http://en.wikipedia.org/wiki/Schr%C3%B6dinger_equation is easily explainable to laypeople, who will go away fully and precisely understanding it and its implications. I doubt that many people could go away even vaguely understanding what it’s about.
If one is a physicist, then one needs to have mastered this material. If one hasn’t, one simply is not a player. No physicist in the world would be interested in the opinions as related to physics of people who hadn’t mastered the subject.
I think it is possible to discuss ideas of Chinese medicine over a cup of tea, but ultimately, one encounters similar problems to the above. Chinese medicine is a systems based theory, so that concepts are interrelated and interdependent. One can try to teach a small part, but one will then discover that to really understand that part, one needs to understand something else, and then something else again. That’s how it is.
It seems to me that some people on this forum would like to believe that Chinese medicine is not complex, but that’s not the case.
You wrote:
“all I’ve ever seen from TCM people and alternative medicine people in general is bold claims backed up with evasion.”
I haven’t been evasive. I’ve said that I and many Chinese medical practitioners would actively welcome rigorously conducted clinical research that was designed so that the methodology of Chinese medicine was properly represented. I even appealed to people on this forum to support such research being done, because it is hard to get funding.
In addition, I have welcomed university education, precisely because it is associated with rigor and amenable to increasingly high standards, and I’ve welcomed regulation as a method of ensuring high standards.
You and others can’t possibly accuse me of being evasive.
[…] This post was Twitted by Blue_Wode […]
@Niels
The whole point of this and related posts is to show that university education in this area consists largely of propagating myths and teaching kids how not to think critically. Anything less rigorous is hard to imagine. These are not courses taught by real academics. Many of the teachers are part time and spend the rest of the time in private clinics treating anyone who is gullible enough to pay.
@David Colquhoun
I disagree with your assessment of current courses, but even so, you left out the sequel to my statement which is integral to what I’m saying:
“I have welcomed university education, precisely because it is associated with rigor AND AMENABLE TO INCREASINGLY HIGH STANDARDS”.
I am advocating higher standards, and what’s more, in a context in which there is direct public accountability.
Your proposal would involve Chinese medicine training being removed from exactly that context – the university context – in which science can be best taught, and where there is public accountability. Therefore, your proposal would lower training standards.
I would think that everyone was in agreement that highest possible training standards are desirable. That requires that Chinese medicine continues to be taught in universities.
@Niels
I’m glad you want higher standards. Me too.
But I fear that you find yourself in the same dilemma as the vice-chancellor of the University of Westminster. After his internal inquiry, it has announced that he wanted to make the courses more scientific. I’m afraid that will not be possible, simply because it is impossible to imagine that anyone with a serious interest in science would be willing to teach a subject like that.
You seem, like so many other alternative medicine people, to assume that when someone gets round to doing the tests, they will come out positive.
In fact for acupuncture they have already been done and turned out largely negative, so you can’t have that in a university.
For TCM they mostly haven’t been done. You really can’t expect a university to run a degree in a subject that could, very easily, turn out to be almost all myth. The tests have to come first.
@David Colquhoun
David,
It is possible to make the course more scientific in many respects. There may be some individuals who would not wish to be associated with the teaching of Chinese medicine, but there are many others who would not have this objection. As a matter of fact, there is a growing collaboration, internationally, between scientists and Chinese medicine practitioners, who are exploring what both Chinese medicine and science can learn from each other. There are many variations on how this can be done, but it is happening, and moreover, it is happening at an ever accelerating pace.
There is a wide perception that Chinese medicine has something valuable to offer, and at least some scientists, being essentially curious people, will be intrigued to investigate areas that provide scope for novel insights. The Chinese government itself is very much encouraging the development of this field, and with the resources of such a powerful state behind it, one simply has to accept that this phenomenon is unstoppable.
This field is not the only game in town, but it is one of the games in town. Universities in the UK have a possibility of gaining kudos to the extent that positive developments ensue from this.
That’s the great thing about science. Science involves taking chances. Max Planck took a chance in assuming the possibility of quantization in nature, and it was an inspired guess, even though he himself didn’t understand the full ramifications of his idea. In a sense, scientists wishing to learn something from Chinese medicine are taking much less of a risk, because it remains extremely unlikely that a great civilization such as China would not have made important discoveries and innovations in an area as important as medicine.
@David Colquhoun
David,
You wrote:
“In fact for acupuncture they have already been done and turned out largely negative, so you can’t have that in a university.”
That is very much a matter of interpretation. The analysis of clinical trials depends on many assumptions. I personally know serious researchers who do not agree with the specific interpretation you present here.
In 2003 the WHO issued an official document that presented a very positive interpretation of clinical evidence for the treatment of many conditions with acupuncture. That document can be viewed at http://apps.who.int/medicinedocs/collect/medicinedocs/pdf/s4926e/s4926e.pdf
At present, the Chinese government is conducting a great deal of clinical research into acupuncture to provide better data than currently exists. I expect that once that research is available, we will all have much more to talk about.
And for a third time,
Here is some evidence for TCM, as requested by several people on this page:
Click to access tcm_evidence.pdf
Click to access tcm_evidence.pdf
Click to access tcm_evidence.pdf
Niels,
You wrote “the Chinese government is conducting a great deal of clinical research into acupuncture to provide better data than currently exists”
If Ministry of Health in China were really able to provide an objective investigation, then TCM would not have been a problem. For example, they have approved at least 109 Chinese Medicine Injections on patients, which have been applied for over 30 years or billions times, without any standard clinical trial. Much concern has arisen recently after reports of patients’ death, and The State Food and Drug Administration (SFDA) in China had to repeal the usage of one or two Chinese Medicine Injections every several months in these several years.
http://my.cnd.org/modules/newbb/viewtopic.php?mode=viewtopic&topic_id=46759&forum=6&start=0&viewmode=flat&order=0 (sorry the post is in Chinese)
As for the “data” itself you expected, I recommend this research:
“Randomized trials published in some Chinese journals: how many are randomized?”
http://www.trialsjournal.com/content/10/1/46
@Stefan
You already sent that link 4 days ago and I gave a preliminary response 3 days ago.
Here is a report in English about accidents caused by TCM injections in China:
http://china.org.cn/health/2008-10/14/content_16608648.htm
The report did not mention that there was any trial with scientific meanings before Ministry of Health of China allowed the usage on patients. Some injections are suspended, only because they hurt or killed too many patients.
Therefore how can you believe that Ministry of Health of China is trustable to test the effect of TCM.
How is it that whatever debate about alternative therapies I stumble upon do I find such playground comments being made by the alternative camp?
@Stefan wrote:
“…unlike the rumours that suggest you are a pharmaceutical company stooge, i suspect you simply have too much time on your hands since the, extremely sad, closure of the UCL Pharmacology Dept and the loss of your Chair.”
The fact that no one comment has picked up on this suggests to me that everyone is a bigger person, or more mature than I am but it is slightly infuriating
A lot of credibility is being lost here, regardless of how many letters follow the name.
With regards to what is being taught in TCM lectures. The complete lack of references in the slides appear to suggest that the material was plucked out of thin air.
Yes, the pompous half-insult isn’t really worth a serious comment,db, but it is rather typical of the Alt.Reality crew’s childish attempts at a put-down.
As any fule kno, DC reached formal retirement age a few years back and became an “Emeritus” Prof, ditching his admin commitments whilst returning full-time to his research laboratory. At the risk of embarrassing him, publishing in Nature past one’s 70th birthday speaks for itself to my way of thinking, not to mention running this blog on the side. Anyway, long may he continue.
Of the around 15,000 words on this page, about 100 of them have been devoted to commenting on the 11 page research document I posted a week ago (post 31) following specific requests for such data, and subsequently re posted twice since.
In those 100 words DC says “A first glance shows that it is not a systematic review”, yet the 2nd and 3rd paragraphs of the document reads:
Systematic reviews and clinical trials show unequivocal benefits to
patients from acupuncture for several conditions, especially chronic pain, and
show that acupuncture can be cost-effective… Clinical trials have shown clear benefits to patients from Chinese herbal medicine for some conditions” (refs within)
Even its harshest critics (Ernst and White, 2001) found that “A systematic review of prospective studies of acupuncture safety led the authors to “confirm that the true incidence of serious complications is low”.
In that post I also wrote:
“Without the backing of the pharmaceutical industry and the support of the NHS it is more or less impossible to get the funding and recruitment to do large-scale clinical trials, but this you all already know. However, my experience is that some people, lets call them Flat Earthers, are quite capable of ignoring evidence that does not sit comfortably with their world-view. We shall see.”
Well, we have seen. It is not lack of evidence that is the question, but rather unwillingness to acknowledge the evidence that does exists, even if “More research data is needed”. No doubt someone will now again incorrectly cite text from the TCM Evidence document, but anyone with an open mind reading this page will now have insight into the scientific bias evident here.
There is a lot I would like to say about the comments on Chinese medicine but I doubt it would make much difference to entrenched opinions. However regarding research into efficacy it is worth looking at this link on our website (http://www.jcm.co.uk/catalogue.php?catID=705&opener=0-691-705) for fairly extensive coverage of the last ten years or so of mostly acupuncture research, nearly all of it published in non-Chinese peer-reviewed journals.
sorry, this is a better link: http://www.jcm.co.uk/catalogue.php?catID=691&opener=0-691&fe=a8b34aa2e5721420a58547c740832572
Alternative medicine advocates are such determined cherry pickers that some of them must own their own orchards.
Stefan’s evidence for TCM” document that he keeps banging on about, and linking to, says:
– missing out point (i): often compared to no treatment or an inadequately concealed sham treatment (i.e. not necessarily compared to standard conventional management)
– and missing out point (ii): “effects are only small” (i.e. clinical relevance debatable), and also short term (lasting benefit not demonstrated).
Edzard Ernst in his overview of Cochrane reviews on acupuncture describes Furlan as “inconclusive”. If one actually looks up the Furlan et al. Cochrane review then it also says some other things that Stefan’s “factsheet” does not quote, and show why Ernst reached this conclusion. For instance in the plain-language summary:
And again in the main conclusions:
The idea that this demonstrates “unequivocal” efficacy strikes me as laughable. There are some subjective short-term / immediate effects in chronic pain. The obvious likelihood that these are “theatrical placebo” / expectation / therapist effects is not discussed in Stefan’s document, and nor is the lack of any evidence that there is any lasting benefit.
For lower back pain, as DC has repeatedly said, nothing really works, so all “therapies” are equivocal. In which case, the cheapest – cheap OTC painkillers that people are familiar with and advice to stay active? – would be the obvious option.
Anyway, if that Cochrane review is Stefan’s idea of demonstrating “unequivocal benefits” of acupuncture, then several pairs of rose-tinted spectacles must accompany the cherry-picking. Or I could have said “wishful thinking and vested interests”.
To conclude, Stefan wrote:
Happy I have been able to oblige, Stefan. Though I suspect we will differ on “incorrectly”.
*Applauds Dr. Aust.
It is good that you have taken the time and effort to refer to the original research documents and reviews.
I will be interested to see Stefan’s reply in due course.
Excellent work Dr Aust.
It gets tedious to go through all the cherry-picking and third rate papers that pass for evidence in the world of Chinese medicine. You have done us all a service by taking on the job.
As you’ve said, David, it often seems to reduce to whether you see a rather thin gruel of mostly equivocal evidence, with the odd weak positive in the less rigorous studies, as:
(i) evidence that the result is tending asymptotically towards “placebo”; or
(ii) evidence that more studies are required which will of course prove your beloved intervention works.
Scientists are obsessives with pet theories too, of course, but I do think one of the main differences is that scientists in the position the Alt-Med gang are would see the writing on the wall at some stage, dump the unpromising idea, and move on to something else. But of course faith trumps rationality in Alt.Reality.
I am somewhat reminded of a long debate / argument I had about chiropractic with someone styling him/herself “Cochrane Reviewer over at the Science Punk blog some months back. My comment that best summarises my standpoint on research into implausible therapies is this one here).
One of the main points about the interpretation of research is that one needs to scrutinise individual pieces of research to ensure that it meets the various criteria one has decided upon to make it reliable.
The ‘cherry-picking’ that the anti-CAM sceptics on this site are castigating CAM practitioners for is equally true for the cherry-picking that takes place in research used in Cochrane Collaborations, or Prof. Ernst’s evaluations, etc. (I emphasise that I haven’t chosen to use this derogatory term. It would be better to speak of rigorously sorting through the details of how research has been conducted, to discover flaws or strengths.)
There’s a strong tendency for individuals to cherry pick the type of studies or evaluations that lead to the conclusions that those individuals are searching for in advance.
I would suggest that when one performs a careful analysis of clinical evidence for CM, one which takes account of the scientific rigor of the trials, but also the rigor from the point of view of how well that research reflects proper CM therapeutic practice, generally results are inconclusive at this time. It may be that more work needs to be done in analysing Chinese clinical trials, which on the whole seem to demonstrate positive results for CM. It is draconian, and possibly bigoted, to suggest that no clinical trials ever performed in China have had a rigorous scientific methodology.
The problem with research into CM conducted in the West is that it is fraught with poor protocols and other objectionable features that make a great deal of this research unreliable as a method of evaluating good CM practice. See Birch’s article ‘Reflections on the German Acupuncture Studies’, http://www.jcm.co.uk/media/cms/File/Birch.pdf , for criticisms of the widely quoted German acupuncture trials. Birch has done work associated with Harvard University.
Beyond the question of research (and please do look at the link I posted earlier – there is a great deal more research out there than you might be aware of) I would like to raise a different point. A casual look at the history of inventions and early scientific discoveries shows that the great majority originated in China, often many centuries before they were ‘rediscovered’ or adopted in the West (interestingly immunisation against smallpox is one of these). Prof. Joseph Needham in his multi-volume ‘Science and Civilisation in China’ suggests that the reason for this extraordinary feat is the emphasis on observing nature as it is, without preconceptions, that sprang from Taoist thought and philosophy. This approach – which gave rise to so much original discovery – also gave rise to Chinese medicine, an all-embracing medical practice and philosophy that has occupied some of the best minds in China for a couple of thousand years and is still extensively practised within the medical system in China. I would say that encountering a phenomenon like this, the appropriate ‘scientific’ response is one of interest, respect and curiosity. The wrong approach is to hear a few ideas that seem unfamiliar and strange and arrogantly dismiss an entire system of medicine. There is more than one way to view the human organism in health and sickness and – wonderful as it is – Western medicine is only one of these. It has been phenomenally successful in some areas but much less so in others, including many of the chronic diseases that we suffer from. Given that we all know the deficiencies of modern medicine, and given that the evidence of our unprejudiced senses should tell us that in Chinese medicine we are dealing with a major system of human thought and two thousand years of clinical experience, a healthy dose of humility and willingness to learn seems fitting.
@Peter
What you say about the value of Chinese thought is true in my opinion, although I would have to qualify it. I don’t think one can say that the Chinese, or Taoists in particular (and much Chinese medicine was influenced by other strands, such as Neo-Confucianism, although Neo-Confucianism itself was influenced by Taoism) were without assumptions. There are assumptions, as is equally true of all forms of knowledge. The point is to not just dismiss those assumptions out of hand, which is what some people on this site are doing, because they differ from modern medicine.
If we accept a neutral position, such as the scientific method to arbitrate, then one has to do at least initially do justice to the assumptions that are made in Chinese medicine. I would argue that this is not happening, certainly not in the West. Most Western research into acupuncture does not reflect good quality Chinese medical practice.
@Niels
The whole point of Cochrane reviews, and of Ernst’s work, is to look at all of the data, and so to avoid cherry picking
@peterdeadman
I certainly don’t believe that I or anyone else would “arrogantly dismiss an entire system of medicine”, All we ask for is good evidence. The fact that the theoretical basis has been long outdated is secondary. If you can show me a series of well-controlled RCTs that show reproducible beneficial effects than I’ll believe anything. There is no arrogance in asking for evidence. The arrogance lies with those who claim to be exempt to from having to produce it.
Hi David
Have you looked at the web link I posted above?
@ David
You wrote:
“The whole point of Cochrane reviews, and of Ernst’s work, is to look at all of the data, and so to avoid cherry picking”
In that process, many decisions are made, based on prior assumptions and attitudes, about what to include, what to not include, etc. The end product implicates those various assumptions and decisions. Among other things, Prof. Ernst and the Cochrane Collaboration researchers are not looking at the quality of the acupuncture from a traditional Chinese medicine standpoint, and there is a tendency to consider that all types of acupuncture are equivalent.
This would never be considered acceptable in conventional medicine. I provided an example above in my comments about UTIs.
PS – I think it would be helpful for people to look at the Birch article which I quoted earlier:
‘Reflections on the German Acupuncture Studies’, http://www.jcm.co.uk/media/cms/File/Birch.pdf
This typical Alt.Med appeal to the adoption of “metaphorical concepts” misses the point. If you have heart failure because your cardiac muscle, is damaged, or diabetes because you are not producing insulin, or autoimmume disease, or cancer, then “conceptualizing” your illness in terms of “humours” or “energy flow” does nothing whatsoever to deal with your underlying pathophysiology.
The only place where this appeal has any traction is in dealing with the psychological component of illness – and there I see no pressing reason to replace orthodox medical psychology, which attempts to work in testable ideas and concepts, with a two thousand year-old mystic belief system.
In addition, it is endlessly apparent that many alternative practitioners in the UK cannot tell the difference between metaphorical construct and physical reality, including real physical illness. Hence the ridiculous claims to treat cancer with energy healing and the like.
One of the significant differences in the German system is that there interventions like acupuncture are generally applied by medical specialists, who can hopefully tell the difference between the real and the metaphorical.
Hello all. First post here but I have just read this discussion and thought I would have my tuppence worth.
Niels. I am interested in your thought experiment about the classical and the modern physicist. I think that you are missing an essential part of how science works. If your eminent classical physicist were to time travel and meet a modern equivalent I am sure that she would endeavour to update her classical colleague’s knowledge. Probably she would go about it by starting at the point where Mr ECP’s knowledge left off and then reviewing subsequent developments in roughly chronological order.
Now, this is the key point. For each development that Ms Modern Physicist describes she is also able to describe, and in many cases demonstrate, the experimental evidence that led to that theoretical development. Thus the state of modern physics builds from classical physics in incremental stages, each of which is underpinned by solid evidence.
If Chinese traditional medicine were scientifically based then you would be able to achieve similar steps of understanding, backed by solid evidence, along the way to comprehending the full theory.
Can you tell us what is the first such step?
@Bogusman
You wrote:
“If Chinese traditional medicine were scientifically based then you would be able to achieve similar steps of understanding, backed by solid evidence, along the way to comprehending the full theory.
“Can you tell us what is the first such step?”
There is a strong consensus within the field of Chinese medicine that, as Stephen Birch recently expressed it, “traditional forms of acupuncture practice have been hardly, if at all, investigated in the West” Birch, S. ‘Filling the Whole in Acupuncture’ in European Journal of Oriental Medicine, Vol. 6 No. 2 2009, p25. While there has been a fair amount of clinical research into ‘acupuncture’, this ‘acupuncture’ doesn’t conform to proper oriental practice.
For the sake of clarity, I will speak of a need for ‘paradigm sensitive research’. What I mean by this term is research that employs high quality oriental practice in a manner that represents it accurately. In order to do paradigm sensitive research, one has to devise rigorous research methodology that both satisfies the need for scientific rigor in the general sense, and simultaneously enables paradigm sensitive research. This type of work is being done internationally. In the UK, it is being done at universities such as Southampton, Westminster and York, often with grants provided by the government. In the US, similar work is being done at Harvard University.
You may be interested in the recently published book, ‘Acupuncture Research’ One can get the flavor of this book at the following website: http://www.elsevier.com/wps/find/bookdescription.cws_home/713776/description#description
It is therefore important to stress that paradigm sensitive research is currently being done, but it is at a relatively early stage.
In answer to your question, this is the first such step.
But I thought that the whole structure of theory was already in place. What I am asking for is not new research but the evidence that has led step by step to the construction of that theory. If the whole elaborate theory is already known then the stepping stones must be known.
@Bogusman
Chinese medicine is highly evidence based, in the particular ways that clinical observation corresponds to theory, and in turn to therapeutics and monitoring of the results of treatment. The process of this development has spanned over two millenia, with an incremental body of medical literature.
The reason I’m highlighting modern clinical research is that there needs to be a bridge to satisfy the needs of normative investigative methodology within our culture at present, and the style of scientific endeavor that characterized traditional Chinese medicine.
Let’s be clear: Chinese medicine practitioners are engaged in very sophisticated activity reconciling modern science with traditional Chinese knowledge. This activity is not taking place in dark alleyways, but rather in places like Harvard University.
So what is the first step – backed by clear evidence – that we can take to understanding the theory? I don’t understand why that is such a hard question for you to answer, or even address.
@Bogusman
Probably the very first step in understanding the theory is to read a good introductory text on Chinese medicine, such as Ted Kaptchuk’s ‘The web that has no weaver: understanding Chinese medicine’.
Either I am not expressing myself clearly or you don’t really want to answer.
Go back to the physicists. One of the first pieces of evidence that our modern physicist might describe is the result of the Michelson-Morley experiment that demonstrated the non existence of the “ether” and the constancy of the speed of light regardless of the frame of reference of the observer. This was a critical building block leading to Special Relativity.
What is an equivalent piece of evidence that leads towards the construction of the theory of Chinese medicine?
@Bogusman
I have answered your questions in depth. I’m outlining the course of action that is required. I’m not saying you must do this if you don’t want to: there’s no coercion involved.
I’m reminded by your comment, of Feynman’s answer when he was asked, if all scientific knowledge was lost, what single comment would put people on the right track to rediscovering scientific knowledge. His answer was ‘Everything is made of atoms.’
Unfortunately, I cannot think of such an elegant and simple answer in the case of traditional Chinese medicine. If I could, I would be very happy to present it here. But in the absence of that, my other advice is the best I can do.
Following from my previous comment.
Bogusman wrote:
“Go back to the physicists. One of the first pieces of evidence that our modern physicist might describe is the result of the Michelson-Morley experiment that demonstrated the non existence of the “ether” and the constancy of the speed of light regardless of the frame of reference of the observer. This was a critical building block leading to Special Relativity.”
To consider your specific comment more carefully, I agree that within the history of physics, it is possible to cite individual instances of experimental evidence to provide rationales for the development of theory, for example, the spectra in black body radiation and photoelectric effect for quanta, and the Michelson-Morley experiment in relation to Special Relativity. Sometimes this evidence doesn’t relate to the actual progression of theory: for example, Einstein said that he was not aware of the Michelson-Morley experiment when he developed his theory of Special Relativity.
However, it is important to recognize that there is absolutely no reason to expect to find similar instances when considering two entirely separate traditions, such as Western science and traditional Chinese medicine. In this case, the differences between the two traditions are inevitably going to be much more complex than that in the type of example you cite, when progress was made stepwise within a unique tradition. It is precisely because of the much greater complexity obtaining between two highly developed traditions that one can’t find the simple bridges you are requesting. One has to accept the complexity, and proceed from there to learn Chinese medicine in all its complexity, and then consider appropriate scientific methodology to bridge the separate traditions.
This is a painstaking process. This work is taking place, but it is in its early stages. Many scientists and doctors are excited by the prospect of making discoveries, employing the medical knowledge that was accumulated by a major civilization.
Unfortunately, the research into Chinese medicine in the West to date is on the whole extremely simplistic, and its conclusions invalid in respect of Chinese medicine, precisely because it doesn’t reflect high quality Chinese medical practice.
I’ll leave this discussion with one further issue to contemplate. Why is a premier institution such as Harvard University interested in this process of exploration of Chinese medicine? I think the answer is obvious: Harvard wants to be at the cutting edge of knowledge, and this is one of the cutting edges.
Niels
I’m very sad to say that Harvard, and most other US univerities, care more about money than principles, Because of political pressure, a vast amount of NIH money has been given (via NCCAM) and there is a lot of money from the Bravewell Foundation too. Unlike in the UK. most people in the USA are not paid by the university but by the grant. The university makes money from everyone it appoints in his way. Money counts more than principles, sad to say. More details in Integrative baloney @ Yale -watch the video,
Niels says in comment 76
This effectively claims that most acutpuncture in the west is rubbish, but there is a true version in China.
It’s very close to the standard claim that ‘all the psychics who have been tested are frauds, but this untested one is the real thing.’
If there is a valid oriental acupuncture, and the acupuncture done in the west is invalid, then regulation and University courses should wait for it to be properly characterised. In the mean time, all the acupuncture therapists in the west should be considered charlatans.
@davidp
That is a good point. Niels seems to be hoist with his own petard.
Re the 2 comments immediately above:-
I shouldn’t need to be repeating myself, because this suggests that people simply haven’t bothered to read my postings, nor the material I have referenced, such as Birch’s ‘Reflections on the German Acupuncture Studies’. http://www.jcm.co.uk/media/cms/File/Birch.pdf
What I have been saying is that the research in the West has overwhelmingly not represented correct CM practice. I did not say that there were no good acupuncturists, or no good acupuncture – you will not find those comments in anything I wrote. Nor can one validly infer those points from anything I’ve said.
@ Niels
You seem to feel that Birch’s reservations regarding the GERAC trial render western research invalid. But the GERAC authors went to great lengths to try to get a consensus on what appropriate management as per the principles of TCM should be.
(Molsberger et al. 2006 THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 12, Number 3, 2006, pp. 237–245).
One wonders what you would accept as a fair trial (I am tempted to suspect that you might make that decision post hoc in light of its findings).
@neoconnell
I believe that it is important that the methodology of all clinical trials be looked at very closely and carefully. This is a generally accepted principle in the evaluation of research. It is important that this type of assessment be carried out in respect of the paradigm sensitivity of trials where Chinese medicine is involved. In many or most cases in the West, the trials do not reflect correct working methods from the point of view of CM practice, in multiple ways. Birch discussed certain issues, but his paper is far from exhaustive.
It’s fairly early days in all of this. The first step, as I’ve been saying, is that methodology into how to conduct paradigm-sensitive research has to be developed, and after that, research done. I’m not talking about a pipe dream: this work is proceeding, including in association with Harvard University, and certain British Universities. But it’s going to take time.
You ask how I would feel if I didn’t like the results. The answer is, if the research was methodologically rigorous, and there was enough evidence to draw a firm conclusion, I would accept the conclusions.
davidp says @ 85 “It’s very close to the standard claim that ‘all the psychics who have been tested are frauds, but this untested one is the real thing.’”
this reminds me of Harry Huodini’s investigations of various spiritualists, mediums & so forth. After his mother died Houdini went to some considerable trouble to catch spiritualists who were using hidden lights and assistants to con the audience. Houdini points out in his book that often this made no difference to the followers of a particular spiritualist – they would just believe that on all other occasions the spirits were real, but the spiritualist being unable to call the spirits on the particular occasion had to resort to trickery just once -an unshakable faith.
That’s why I think Neils comment @89, that he would accept the conclusions of rigorous experimentation is important. Our point is that the rigiorous testing has already happened.
One trial with its strengths and weaknesses tells us a little. Lots of trials all with different strengths and weaknesses that reach similar conclusions tell us much much more. The idea that no western research has reasonably tested TCM is absurd. Most of it was performed by advocates of CAM.
Kaptchuk calls this “rescue bias”: whereby unexpected or unwanted results are automatically considered an indication that the experiment was flawed.
@andrew & neoconnell
Your comments don’t hold up in relation to the quality and type of work that has gone into these trials.
I could get technical and discuss in depth the reasons for these statements. Of course, one would have to look at clinical trials one-by-one.
There is nothing new in my observation. People in the CM field have been discussing these matters for many years.
I’d like to ask whether anyone who agrees with andrew and neoconnell’s assessment – including those individuals – have training in traditional Chinese medicine, and if so, how much training.
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I would guess that there many thousands of trials so far conducted and published in peer-reviewed journals into different aspects of Chinese medicine … mostly acupuncture but also Chinese herbal medicine, tai chi etc. I would say more show positive results than absence of effect. The problem with this debate is that most of the ‘scientific’ critics of Chinese medicine simply don’t know what they’re talking about. They don’t bother to approach this substantive system of medicine with any real curiosity (and thus demonstrate both cultural arrogance and a lack of any true scientific openness), nor do they take an objective look at the research that has been conducted. Instead, they simply scan the data – on the theory, practice and evidence for Chinese medicine – to find irritants they can respond to. This is classic close-mindedness and there is little that can be said in response to these kind of attitudes that will make any difference. It reminds me of the situation three decades ago when the proposition that diet could influence the onset of cancer (put forward by the natural food movement) was treated by the medical profession with the utmost scorn and arrogance.
peterdeadman
I notice that you say “I would giess that . . . “. You guess, but the critics have actually taken the trouble to read the literature. If all you are doing is guessing, I’m surprised that you think you have anything to contribute to the discussion.
It never ceases to amaze me that people who prefer to look at all the evidence, rather than believe myths. constantly get accused of arrogance.
I notice that you write
This is plain silly, The causes of disease were discover in the great advances in medicine in the 19th and 20th century and owe essentially nothing to the ancient myths of Chinese medicine.
You also wrote
Contrast this with the 2008 Cochrane review which concludes
You seem to be wilfully ignoring the best evidence that’s available.
The real arrogance lies in treating sick people using unproven or disproved methods. Real medicine is not entirely free of that vice. Chinese medicine consists almost entirely of unproven and disproved treatments. Has it not occurred to you that this form of arrogance can kill people?
As anyone who bothers to actually read other people’s words can readily see, “I would guess that there are many thousands of trials so far conducted and published in peer-reviewed journals into different aspects of Chinese medicine” refers to a guess as to the numbers and has nothing to do with reading the material – which I have been doing for many years.
As for Chinese medicine’s understanding of the causes of disease, I would say it was a couple of thousand years in advance of modern medicine in understanding the effects of diet, exercise and the emotions on health and disease and was sophisticated enough to practise immunisation against smallpox in 1000 CE. If you weren’t so narrow-minded you would find there is much to admire and learn from Chinese medicine, as well as much to criticise and that would be a fair approach to modern medicine too. As for killing people, there’s no competition. Iatrogenesis in modern medicine outscores Chinese medicine by a factor of tens of thousands.
peterdeadman
I’m not a medical doctor, but a physicist. I haven’t looked at any papers on research into TCM; all I’m doing here is writing about my opinions, and my reasons for them.
My starting point is this: why should we expect TCM to tell us significant things that we don’t already know? Isn’t this like expecting to learn from medieval Chinese astronomy, geography, or indeed physics? Do these (or any other) disciplines have any significant messages for their modern counterparts, other than their historical interest? If so, what? If not, why should medicine be different?
I don’t see this as China vs. the West. When I teach chinese students I teach them physics, not Western Physics (whatever that might be). I’m certainly not suggesting China is backward. However, TCM is (according to my understanding) something with its origins in the ancient past and to me (speaking as a scientist) this is not encouraging! Very little truly ancient physics is worth knowing about today (Archimedes’ principle is an exception). It’s true that modern ideas have developed from ancient ones, but in doing so they have largely replaced them. Is the same not true of the modern view of the body and its systems when compared with the many traditional views?
As I’ve said, I’m reasoning about medicine (about which I know little) by analogy with physics and astronomy (about which I know a lot more). I’m sure you’d dispute this analogy, and I’m not in a position to argue with you. However, I hope you can see that I’m not merely being “narrow-minded”. Arguing by analogy is not an unreasonable thing to do, and if the analogy is a bad one it would help if you could explain clearly a way in which it is wrong. In your view, what makes traditional Chinese medicine different from other areas of traditional knowledge?
Hello Dr Aust
Please could you explain further what you meant by this:
“One of the significant differences in the German system is that there interventions like acupuncture are generally applied by medical specialists, who can hopefully tell the difference between the real and the metaphorical”
Are you saying that the German doctors (about 20,000 of them I think) are doing some sort of real acupuncture whereas in the UK it’s metaphorical acupuncture? Or are the UK doctors and physios (quite a few thousands of them too) also doing real acupuncture and it’s just the non-medics who are seduced by metaphorical concepts?
Given that
“In the case of acupuncture there is quite good evidence that it doesn’t work to any useful extent” (DC)
it seems very funny that all those level-headed medical specialists are using acupuncture. Do know they something that DC doesn’t?
my recent post has not been published – is there a reason?