Ethical issues & conflicts of interest faced by the TCM practitioner

July 16, 2003

It is my view that the importance of beneficence far out-weighs non- maleficence and the need for evidence-based research, although it is much needed and every effort should be maintained to cultivate its growth. The ethical argument for the administration of a non- evidence based medicine should be swayed above-all towards the need to treat human illness. Therefore, the issue of prescribing herbal formulas to humans is in truth ethical sound even if the evidence disallows it. Attilio

Hi Attilio,

Thank you for your post. I'm noticing no one responded to your meditation on ethics which I feel is central to some of the conflict that currently exists between WM an CM.

As a point of information, I've not seen an MD curriculum with ethics. Are medical ethics a part of your Oriental medicine degree? Ethics is a large part of every masters in nursing degree I've seen. I had to take a graduate seminar in ethics regarding genetic engineering in my various graduate programs leading to an engineering certificate. I sense that ethics is largely missing in our current medical paradigm from both purely clinical as well as research orientation. There's plenty of legislation and litigation, but not a whole lot of medical ethics being addressed above the MSN level.

The paradigm of WM research seeks molecular mechanisms, but as you imply most responsible pharmacologists will note that no such bio-assay exists for solutions that contain thousands of interacting chemical compounds. Our HPLC markers are for the highest independent peaks of chemical compounds that are easily characterized. These are useful for testing batch work in factories. None of these could be considered "active ingredients" apart from the rest of the solution. They are markers for use in manufacturing. Clinical studies can and are done by the thousands these days for CM formulas, but invariably the investigators indicate that what ever the results are, the biochemical mechanism is unknown. In my humble opinion, I view this as perfectly fine. I hope for more studies regarding clinical outcomes and less pressure on ferreting out molecular structures. Of course, molecules is where the money is. Clinical outcomes is where the healing is.

Emmanuel Segmen

Merritt College, Asia Natural

July 16, 2003

the biochemical mechanism is unknown

>>>>This is also true for many approved pharmaceuticals

Alon

July 17, 2003

It is my view that the importance of beneficence far out-weighs non- maleficence and the need for evidence-based research, although it is much needed and every effort should be maintained to cultivate its growth. The ethical argument for the administration of a non- evidence based medicine should be swayed above-all towards the need to treat human illness. Therefore, the issue of prescribing herbal formulas to humans is in truth ethical sound even if the evidence disallows it. Attilio

Hi Attilio,

Thank you for your post. I'm noticing no one responded to your meditation on ethics which I feel is central to some of the conflict that currently exists between WM an CM.

As a point of information, I've not seen an MD curriculum with ethics. Are medical ethics a part of your Oriental medicine degree? Ethics is a large part of every masters in nursing degree I've seen. I had to take a graduate seminar in ethics regarding genetic engineering in my various graduate programs leading to an engineering certificate. I sense that ethics is largely missing in our current medical paradigm from both purely clinical as well as research orientation. There's plenty of legislation and litigation, but not a whole lot of medical ethics being addressed above the MSN level.

The paradigm of WM research seeks molecular mechanisms, but as you imply most responsible pharmacologists will note that no such bio-assay exists for solutions that contain thousands of interacting chemical compounds. Our HPLC markers are for the highest independent peaks of chemical compounds that are easily characterized. These are useful for testing batch work in factories. None of these could be considered "active ingredients" apart from the rest of the solution. They are markers for use in manufacturing. Clinical studies can and are done by the thousands these days for CM formulas, but invariably the investigators indicate that what ever the results are, the biochemical mechanism is unknown. In my humble opinion, I view this as perfectly fine. I hope for more studies regarding clinical outcomes and less pressure on ferreting out molecular structures. Of course, molecules is where the money is. Clinical outcomes is where the healing is.

Emmanuel Segmen

Merritt College, Asia Natural