Polls of professional opinion & the future role of AP / TCM in medicine

[Guest guest]

Hi All, and

and I have similar ideas on the importance of science in

medicine, and on the importance of keeping alive the best of ancient

healing concepts and practices. We agree also that WM in the future

will integrate ideas from many systems, including TCM, as adjuncts to

more mainstream medicine.

 

That said, we disagree on many issues. This is one of them:

 

Referring to the AP & Hypertension poll,

> Such self-selected polls of anecdotal experiences are considered

> meaningless (because they are). What do you think this will prove?

> and to whom?

 

IMO, the concept of collegiality amongst professionals is based on

mutual support, at least in areas related to their profession.

 

When professionals discuss topics relating to therapy, the primary

assumption must be mutual respect, honesty and trust in the

professional integrity of both parties. Otherwise, any discussion is

a waste of time for everyone.

 

I expect that those who anwser the hypertension polls will do so with

basic honesty. In that case, I expect that the outcome of the polls

will be of interest at least to me, and to the Listers, if not to the

wider medical profession.

 

IMO, Todd may have prejudged the outcome of the polls, and the

purpose for which I want to use the data.

 

Let me give two extreme examples of what might happen, based on poll

data from professionals who have used AP in hypertensive patients:

 

(a) The overall result suggests a very POOR clinical success rate,

say averaging 15% (range 0-30%), taking 12 (range 4-19) sessions to

achieve, and requiring 14 (range 6-30) top-ups/year to maintain.

 

(b) The overall result suggests an incredibly HIGH clinical success

rate, say averaging 92% (range 80-100%), taking 2 (range 1-4)

sessions to achieve, and requiring only 3 (range 1-5) top-ups/year

to maintain.

 

To me at least, outcome (a) would suggest that I should refer any

hypertensive patient to another medical modality immediately, even if

I were to treat that person with AP for his/her general pattern.

 

Outcome (b) would shatter my concept of professional honesty and I

would probably discontinue discussions with the group(s) involved.

 

However, I expect an outcome somewhere in the middle. Also, I have

set up the poll so that I can contact individual respondents whose

claimed results may be of interest to me.

 

As for using these data in a future publication, I see them as of use

if they suggest good results. I am not so naïve as to think that such

polls influence sceptics or opponents, but IMO they may have major

value in the political / PR arena.

 

> Personally, I think our ship has kind of sailed. I no longer think it

> likely that the research I want for our field will ever get done.

 

I agree here! It is unlikely that we will see a spate of good

clinical articles or scientific research projects to give scientific

credibility to broad sections of TCM / AP in the near future.

 

As a professional researcher, I reached that point many years ago. I

know (from " the inside " ) how expensive, slow and difficult it is to

generate research data that meet the standards demanded by sceptics,

not to mention opponents, of AP/ TCM / CAM.

 

THEREFORE, and because politicians and the public are interested in

clinical results and cost efficiencies more than EBM-type " scientific

proof " , I believe that the best hope for a guaranteed future for AP /

TCM lies in the area of PUBLIC RELATIONS and POLITICS, rather than in

trying to tackle the impossible task of proving every aspect of

clinical AP / TCM to the satisfaction of Quackbuster mentalities.

IMO, such people simply do not want to hear; they have decided [for

their own selfish reasons] that's CAM threatens them, and they want

to " bury it " , or at least cut it to the bone and bring the remaining

bits that they accept totally under THEIR control.

 

> I think this will do more harm than good as it will be so easily

> dismissed as statistically insignificant and provide further evidence

> of our professional naivete. Again, we will appear as a profession

> that continually polls it members about standards of care and never

> does any real research to back it up.

 

See my comments above.

 

> If anyone out there actually had sustained regular success with

> hypertension and acupuncture, they should be able to provide

> documentation of long term followup. For over five years, I have been

> requesting documentation of successful long term treatment of even a

> single case of any chronic illness. I even created a database to

> collect the results online. The failure of a single member of this

> group to submit even one such documented case during this time ...

 

this is NOT confined to TCM / AP professionals. Having known

hundreds of clinicians / practitioners in med, vet, and CAM

specialties, it is my experience that practitioners are allergic to

ink (or keyboards) when it comes to writing clinical articles on

their areas. IVAS, several of the Vet AP teaching panel, and I have

tried for >20 years to get vets who use AP very successfully in day-

to-day practice to write up their clinical cases for publication. It

is useless; they (at least the vast majority of practitioners) simply

will not do it. When asked to write up their work, some say something

like this: " I do not need to prove that my methods work; I KNOW that

they work! So, why waste time trying to write papers? Those who do

not want to believe me probably will not believe my papers either.

However, I am happy, my clients are happy and my bank manager is

happy. Anyway, I am too busy to write papers! "

 

> ... speaks volumes more than such a bogus poll ever could.

 

Whoa, Todd! I know that you do not agree with the value of polls, but

why attach the pejorative term " bogus " ?

 

I have explained that I value communication with / information from

professionals. Polls of professionals are a very useful way of

" feeling the pulse " of their experience / opinion.

 

I see the hypertension polls as of great possible use for Listers'

information, AND for use in the POLITICAL / PUBLIC RELATIONS area if

the clinical results claimed are good [but not " overly good " ].

 

> This is a matter to be pursued with proper deliberation by a

> professional organization.

 

I agree. Let them do so, in addition to anything thet we may do as

individuals.

 

> To make a claim for success in treatment yet demonstrate complete

> unwillingness to prove it is a sure recipe for disaster.

 

Unfortunately, that is the reality for practitioners in most med, vet

and related healthcare fields. In their day-to-day work,

practitioners do exactly that every day, leaving the onus of proof

to:

(a) the clinical outcome of their therapy of each individual patient,

and

(b) to the researchers to give scientific credibility and explainable

mechanisms that what the practitioner is doing.

 

We have pitifully few researchers in TCM / AP. THAT is our problem.

And it will CONTINUE to be our problem as regards putting " scientific

respectability " on the clinical work that we do.

 

> A recent UC Irvine study is the first such proof I know of in this

> matter and it flies in the face of traditional practice. See press

> release at http://cmbi.bjmu.edu.cn/news/0402/28.htm

 

I await the outcome of that work with interest.

 

> In about a decade, western medicine will have changed so drastically ...

 

Agreed.

 

> ... that there will be little interest in researching TCM as a gentler

> alternative anymore.

 

IMO, some TCM research will continue (at least on the clinical

applications, +/- in combination with WM methods), especially in the

Far East, and in developing nations that cannot afford WM therapy.

 

However, I am not so sure about China itself. China has lit the wick

of the capitalist candle, and is seeing the first glimmers of a rosy

future in the commercial / competitive mode of capitalism itself.

IMO, we will see very rapid change in China - genetic modification of

plants and medically useful animals, bioengineered and patented

purified medicinal compounds, etc. Those changes have started already

and will accelerate.

 

> We will still play a role in healthcare for several decades to come.

> But for the long run, I suspect history will take another path than the

> institution of TCM as a primary medical system. I now think our

> primary goal should be to show that TCM can lead to improved quality of

> life regardless of age or health. That it can noniatrogenically treat

> symptoms and self-limited conditions. And while it also could have

> played a role in the cure of chronic illness, I think science will

> actually prevail in this domain, thus a strategy of proving TCM's role

> in this area will receive diminishing research funding over time. As

> an example, I don't TCM treats hypertension well, but I do think TCM

> plus drugs results in better management of BP and fewer side effects.

> This is the primary role I envision for TCM herbology - adjunct to drug

> therapy

 

Regardless of the outcome of the polls, I agree that FUTURE AP / TCM

Tx of hypertension is likely to become adjunctive to WM drug therapy

and lifestyle / dietary modifications.

 

Indeed, I agree that (with a few exceptions, such as Tx of myofascial

syndromes, migraine, minor functional disorders, etc) that AP / TCM

Tx is unlikely to be granted " primary " (first-chioce stand-alone)

status in the western world.

 

IMO, even in China itself, there is a real possibility that TCM (as

we " understand " it in the west) will die out quickly. China will move

rapidly into a biomedically oriented mode that will integrate only

the best of its old medical theories and practices and discard the

rest.

 

> ... and it is the subject I will speak to at the upcoming Scripps

> conference. This is what we should rally behind and attempt to prove.

 

I wish you success with your endeavbours on behalf of TCM. Would you

post the text of that lecture to the List in due course? IMO, many

would be interested to read it

 

let us agree to disagree on some areas (such as the value of

polling professionals), and to work together on those areas on which

we can agree.

Best regards,

 

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