Research coming out of China

[Guest guest]

I just finished listening to the latest Blue Poppy podcast, where

towards the end Bob Flaws advocates learning Chinese. I agree with

this and have found the limited amount of Chinese I have learned to be

very beneficial.

 

However, one of the reasons Bob says being able to read Chinese is so

that one can understand reports of research coming out of China. This

sounds good to me as well, but many of my Chinese co-workers here in

Beijing seem to think the research produced by the TCM universities is

not worth much. The people that have expressed this feeling to me are

fresh out of the Master's degree program at Beijing University of

where they were on the research (not clinical) track.

 

I don't think it can be true that all research coming out of China is

doctored, but how do others deal with this issue when approaching

scientific research on TCM from China?

 

Carl

[Guest guest]

Carl,

 

Actually I've heard from some people in at least one U.S. complementary

medical research circle,

something to the same effect...

that Chinese medical research is not " rigorous " , too flexible and sometimes

not completely " truthful " .

In other words, sometimes a mythical result can be published by some of the

researchers out there

in order to push their agenda.

Even if this isn't true, there is a reputation, stigma, rumor that is

attached to this research.

 

I don't think this only applies to Chinese research, but also to

pharmaceutically-backed research in the U.S.

 

What kind of editing happens during the research reporting, who does the

casting for the study groups

and who is financing the distribution of the research reports?

 

Oh... and where do we get tickets for the production?

 

K.

 

 

 

On Thu, May 15, 2008 at 7:05 PM, carlstimson <carlstimson wrote:

 

> I just finished listening to the latest Blue Poppy podcast, where

> towards the end Bob Flaws advocates learning Chinese. I agree with

> this and have found the limited amount of Chinese I have learned to be

> very beneficial.

>

> However, one of the reasons Bob says being able to read Chinese is so

> that one can understand reports of research coming out of China. This

> sounds good to me as well, but many of my Chinese co-workers here in

> Beijing seem to think the research produced by the TCM universities is

> not worth much. The people that have expressed this feeling to me are

> fresh out of the Master's degree program at Beijing University of

> where they were on the research (not clinical) track.

>

> I don't think it can be true that all research coming out of China is

> doctored, but how do others deal with this issue when approaching

> scientific research on TCM from China?

>

> Carl

>

>

>

 

 

 

--

aka Mu bong Lim

Father of Bhakti

 

The Four Reliances:

Do not rely upon the individual, but rely upon the teaching.

As far as teachings go, do not rely upon the words alone, but rely upon the

meaning that underlies them.

Regarding the meaning, do not rely upon the provisional meaning alone, but

rely upon the definitive meaning.

And regarding the definitive meaning, do not rely upon ordinary

consciousness, but rely upon wisdom awareness.

 

 

 

[Guest guest]

Carl,

 

 

 

What you bring up, Chinese research, is a major issue in both the States and

in China. I have spent hours discussing this with colleagues in both China

and the States. At one point I wrote an essay on the topic, intending it for

a book I am working on, however, as of date, I have cut it out, and may

consider publishing it on the side.

 

 

 

But here are a couple simple points that come to mind that I feel are worth

exploring:

 

 

 

1) Many times such research is done by students. To graduate, a major

project is required for most universities. One usually has 2 major choices

for a project. One can spend extensive hours writing a dissertation based on

classical material, or 2nd do some clinically based research. The latter

project (usually on rats or humans) takes far less time than the former and

what many times ends up in journals. (i.e. guipitang with mods for the

treats of anxiety). Since many of the students do not even want to be in

school studying TCM, there is great incentive to finish the project as

quickly as possible, as well as greatly simply it. Hence many times they

doctor the research and cut corners. Therefore without knowing who is

performing the research/ publishing the article, and what incentives are

behind the project etc. makes it very hard to evaluate the useful of the end

result. If even 20% of the results were accurate I think we would be

revolutionizing the practice of medicine, but in my experience, these

results do not pan out.

 

 

 

On a side note: One of the problems with the " system " is that the majority

of graduates end up not even practicing medicine (they have little

interest). Many go into other businesses related (to medicine) or not.

Inintially many do not choose to go to CM school. The one's that do end up

practicing medicine, end up practicing a hybrid Western medicine / CM, not

because there is any superiority in this method, but out of necessity to

survive financially. Hospitals (integrated) pay a salary, while practicing

CM in a private clinic is next to impossible for a new graduate (they must

compete with experienced older doctors). Consequently, the Western medicine

used is usually quite weak, and the CM portion is also overly simplified.

 

 

 

2) Furthermore, this clinical research is very simplified approach to

medicine. It is not how the good doctors (at least that I have observed)

practice in real life. There is a major disconnect from clinical reality and

research you read about. These research articles many times suggest some

kind of " set " protocols or " standard formulas " for a condition (usually a

Western disease). I have seen many in the West adopt these. I highly

question this approach.

 

 

 

Therefore I could care less about 95% of the research in these journals.

Actually I cannot remember the last time I took one of the studies

seriously. I think a large majority of them are inaccurate and would never

base my clinical treatments on such material.

 

 

 

However I agree with Bob, I think reading Chinese is essential to further

develop one's clinical abilities. I respectfully disagree with Bob in what

one should read. One of course has a choice and to each their own. I

personally find reading case studies, older doctor's clinical experience,

and the numerous books written by great physicians throughout the centuries,

is where the juice is really at. If one wants to learn about insomnia, I

suggest foregoing the latest research in JTCM, and read an essay on how an

older doctor has learned to treat it with their over 50+ years of

experience. Hence, more important than clinical tricks wishfully gleaned

from a journal research article is learning how to think in CM framework.

This is what is lacking in the newer CM doctors in China as well as many in

the West. Granted there are great articles in journals with a more standard

CM approach that are well worth reading.

 

 

 

Finally, the integration of WM and CM is very appealing to many. It is

shiny, exciting, and somewhat simple. At one point I was a strong advocate.

However, I a pretty clear that most doctors that practice this style are

guessing as much as anyone else. They have not figured that much out, and

when you see a hodgepodge of pharmaceuticals prescribed with a simplified CM

formula it is hard not to roll your eyes. This integration is quite poor.

The other integration method is the disease based approaches that we read

about (i.e. here is a lupus formula) that many newer doctors try. Again the

results seem less than optimal.

 

 

 

The doctors I respect seem to understand the Western medicine diseases

although still focus on solid CM pathodynamics - They were trained prior to

the major changes where CM was really emphasized. Therefore they have a

solid foundation of classical knowledge. There are just different levels of

integration that everyone must find their own comfort zone with. However, to

truly integrate 2 things, you must be strong in both fields. Most educated

in China (and the West) are now getting a simplified course in both CM and

WM. This seems to be the larger problem. Therefore you get out what you put

in.

 

 

 

Of course there are always exceptions to the rule. There are great doctors

doing all sorts of styles. However this is the way I have perceived the

general trend in major hospitals and institutions in China. The solution is

to look between the cracks. This is why I prefer to hang out in small clinic

settings with older more traditional minded-doctors, who actually understand

CM.

 

 

 

Just my 2 cents.

 

 

 

-

 

 

 

_____

 

 

On Behalf Of carlstimson

Thursday, May 15, 2008 8:05 PM

 

Research coming out of China

 

 

 

I just finished listening to the latest Blue Poppy podcast, where

towards the end Bob Flaws advocates learning Chinese. I agree with

this and have found the limited amount of Chinese I have learned to be

very beneficial.

 

However, one of the reasons Bob says being able to read Chinese is so

that one can understand reports of research coming out of China. This

sounds good to me as well, but many of my Chinese co-workers here in

Beijing seem to think the research produced by the TCM universities is

not worth much. The people that have expressed this feeling to me are

fresh out of the Master's degree program at Beijing University of

where they were on the research (not clinical) track.

 

I don't think it can be true that all research coming out of China is

doctored, but how do others deal with this issue when approaching

scientific research on TCM from China?

 

Carl

 

 

 

__________ Information from ESET NOD32 Antivirus, version of virus signature

database 3104 (20080516) __________

 

The message was checked by ESET NOD32 Antivirus.

 

http://www.eset.com

 

 

 

 

[Guest guest]

One only needs to read them to know the vast majority are complete fabrications.

Ever since i have been to China i lost all trust in any of their literature. We

as a profession never pushed for truthfulness because i do not believe we want

to know.

 

 

 

 

 

 

 

 

 

 

[Guest guest]

Jason

I have one comment and that is i saw case study publications by " Old Drs " that i

know were also not truthful, and skewed if you look deep into the cases. I also

do not think that somehow in older times Drs were for some reason more honest

that today.

 

 

 

 

 

 

 

 

 

 

[Guest guest]

John,

 

 

 

Yes Western medicine is not exempt either. Check out this excerpt from a

recent DFH newsletter:

 

 

 

 

 

" Fudged science?

According to the editor of the Journal of the American Medical Associations,

Dr. Catherine DeAngelis, misleading research is often published in major

medical journals and doctors are lending their names to it. Doctors,

regulators, publishers and others are all taking money, information and

small presents from pharmaceutical companies and being influenced in the

process, said Dr. DeAngelis.

 

JAMA published a paper accusing Merck and Co. of suppressing data that

showed its now-withdrawn pain drug Vioxx was harming patients, and saying

that academic researchers had lent credibility to the company's allegedly

manipulated research by putting their names on the work. Merck and the

independent researchers have denied this and say the journal is mistaken in

this case. But DeAngelis said there is a " gigantic " problem of drug

companies influencing doctors and patients. Her journal presents the Merck

case as a specific example of one facet of the problem. " We have given away

our profession and we have got to take it back, " she said.

 

Source: Guest authorship and ghostwriting in publications related to

<http://rs6.net/tn.jsp?e=001XqOWxasF3MQtksl66EE7mQkbORTiItnB_va-zF5n8O-Oa7r9

j_Fvj61F8BHVFxVCjl8HWjumJyfFREjmd4ciFOlWmkW1VlZMNvFQvmikuiHgW_b9iqPO4agnE6uw

pf9U6AlzxXb8GcxHrTUyvh-ivJ45H61doHfq8MavMvieZ4SAz4XzY6hG6dN3J173C2khThvsO-WM

mQCprqHJw-vgfZlY0gH5MW3Cmzg7tRirh4YKqiAFOYAsO4C3eOF2E_DGoC7ijb20rxI=>

rofecoxib: a case study of industry documents from rofecoxib litigation. "

 

 

 

-

 

 

 

 

 

_____

 

 

On Behalf Of

Thursday, May 15, 2008 11:33 PM

 

Re: Research coming out of China

 

 

 

Carl,

 

Actually I've heard from some people in at least one U.S. complementary

medical research circle,

something to the same effect...

that Chinese medical research is not " rigorous " , too flexible and sometimes

not completely " truthful " .

In other words, sometimes a mythical result can be published by some of the

researchers out there

in order to push their agenda.

Even if this isn't true, there is a reputation, stigma, rumor that is

attached to this research.

 

I don't think this only applies to Chinese research, but also to

pharmaceutically-backed research in the U.S.

 

What kind of editing happens during the research reporting, who does the

casting for the study groups

and who is financing the distribution of the research reports?

 

Oh... and where do we get tickets for the production?

 

K.

 

On Thu, May 15, 2008 at 7:05 PM, carlstimson <carlstimson@

<carlstimson%40gmail.com> gmail.com> wrote:

 

> I just finished listening to the latest Blue Poppy podcast, where

> towards the end Bob Flaws advocates learning Chinese. I agree with

> this and have found the limited amount of Chinese I have learned to be

> very beneficial.

>

> However, one of the reasons Bob says being able to read Chinese is so

> that one can understand reports of research coming out of China. This

> sounds good to me as well, but many of my Chinese co-workers here in

> Beijing seem to think the research produced by the TCM universities is

> not worth much. The people that have expressed this feeling to me are

> fresh out of the Master's degree program at Beijing University of

> where they were on the research (not clinical) track.

>

> I don't think it can be true that all research coming out of China is

> doctored, but how do others deal with this issue when approaching

> scientific research on TCM from China?

>

> Carl

>

>

>

 

--

aka Mu bong Lim

Father of Bhakti

 

The Four Reliances:

Do not rely upon the individual, but rely upon the teaching.

As far as teachings go, do not rely upon the words alone, but rely upon the

meaning that underlies them.

Regarding the meaning, do not rely upon the provisional meaning alone, but

rely upon the definitive meaning.

And regarding the definitive meaning, do not rely upon ordinary

consciousness, but rely upon wisdom awareness.

 

 

[Guest guest]

Alon,

 

 

 

I disagree. I don't see the incentive for fabrication in older case study

books. For example, if one examines Ye Tian Shi's case studies, none of them

were written by him. All were recorded by his students. Many of these case

studies were chosen to demonstrate various aspects of theory. You have to

ask, what reason would they have to lie or make something up? There was much

less incentive to manipulate data and try to deceive others as compared to

now. I can't think of what anyone would gain. However there are numerous

reasons why modern researchers can benefit from manipulating the " facts " .

 

 

 

So I ask you, what publications by " old Drs " are you referring to that you

think are not truthful? And what do you mean " skewed if you look deep into

the cases. " I personally have read 100's if not 1000's of Chinese case

studies and I just don't see evidence or motive for deceit. The most obvious

test of accuracy is when you apply the ideas from a case and they work.

 

 

 

-

 

 

 

_____

 

 

On Behalf Of Alon Marcus

Friday, May 16, 2008 1:23 PM

 

Re: Research coming out of China

 

 

 

Jason

I have one comment and that is i saw case study publications by " Old Drs "

that i know were also not truthful, and skewed if you look deep into the

cases. I also do not think that somehow in older times Drs were for some

reason more honest that today.

 

 

 

 

 

 

 

 

 

 

[Guest guest]

Jason

I am talking about modern " old Drs " , from the hospital i worked at.

The reasons for exaggerations are probably the same, fame by

association. Its just like all these stories about super human feat by

martial art masters often by their students, sometimes they even

exaggerate the acts within their own minds

 

 

 

 

400 29th St. Suite 419

Oakland Ca 94609

 

 

 

 

alonmarcus

 

 

 

 

 

 

 

 

[Guest guest]

Alon,

 

 

 

So I guess we are talking about two different things. I am mainly referring

to published case study books. Of course fame is a motive for embellishment,

although if we only consider this motive, it leaves us with a someone

cynical view. I actually see a more altruistic point of view in CM

historical record.

 

 

 

I do agree though that people have tendencies to exaggerate and produce

far-fetched stories. For example, " that old doctor " giving everyone 60 grams

of fuzi and curing everything under the sun are heard even in small towns in

the US. However, even from those one can many times learn something.

 

 

 

However, I do think that most case study books, especially ones that have

stood the test of time, are of a different breed. They are usually filled

with very down to earth clinical stories. Many start out with errors, or

some mistake in thinking, or just some common problem, i.e. cough, and the

slight deviation from the norm treatment. I see them as lessons and hence

ways to expand one's thinking, not some ego driven proclamation. Most are

not super-human or miraculous, but mere, in-the-trenches treatments. Many

have commentary by later physicians, hence making them essentially teaching

tools. Therefore I have no reason not to trust them. As with anything one

must think critically, but there are some brilliant physicians before us

that have weeded through most of this material.

 

 

 

Many famous case study books are complications of previous physicians.

Therefore someone must have thought a given case was important enough to

include it. This is what I always keep in mind while reading cases. Why is

it included? Sometimes it looks quite basic, but there is usually a lesson

hidden within each formula. However, curing a 10 year-old problem with 1 bag

of ma huang tang, usually leaves me scratching my head more than

enlightening my day to day clinical practice. Everyone has a style of cases

that they like. I personally enjoy ones with mistakes, twists, and turns, as

in the Liu Bao-Yi case and my personal lurking pathogen case that I

published. These types of cases are less " neat " , but seem to represent real

life clinical reality (at least mine). Others thoughts?

 

 

 

 

 

-

 

_____

 

 

On Behalf Of alon marcus

Saturday, May 17, 2008 2:50 PM

 

Re: Research coming out of China

 

 

 

Jason

I am talking about modern " old Drs " , from the hospital i worked at.

The reasons for exaggerations are probably the same, fame by

association. Its just like all these stories about super human feat by

martial art masters often by their students, sometimes they even

exaggerate the acts within their own minds

 

 

 

 

 

 

 

 

[Guest guest]

Jason

I am sure there is a lot to learn for older case history books and by

the way many of the cases i have seen written by the older dr in our

hospital were structured as past mistakes and then resolution, except

that the resolution was often not real. There is something to learn

from all writings including modern research articles, they also

represent some line of thinking that may be useful. I just think

evaluation of medical outcomes is somewhat complex and we need tools

often not used within the CM community even these days with the

information clearly available. Because of the lack of disease specific

understating of CM older literature needs to be evaluated without such

information which truly makes any statement of outcome a little less

valuable. It may be a great CM teaching tool, ie teaching one how to

think within CM parameters and how to apply it clinically but because

all to often we really do not know what disease process is being

treated outcome it too subjective and can too often only represent

natural course of disease. Patient often eventually get getter inspite

of us, medical practitioners of all kinds. As CM practitioner we

clearly do not have a better way of learning CM then the process of

clinical learning either by reviewing case histories or by following

up on what we see clinically. I am not saying this is not an important

process, it is essential. We do however at the same time have to

challenge within our selfs and within our medical community that which

we see. This demands a good understand of clinical pathology, disease

process and the use of objective measurements. Until this is done we

do not know the answers to many questions we think we do.

 

 

 

 

400 29th St. Suite 419

Oakland Ca 94609

 

 

 

alonmarcus

 

 

 

 

 

 

 

 

[Guest guest]

Alon,

 

 

 

I am curious how you know that the resolution was not real?

 

 

 

-Jason

 

 

 

_____

 

 

On Behalf Of alon marcus

 

 

 

 

 

Jason

I am sure there is a lot to learn for older case history books and by

the way many of the cases i have seen written by the older dr in our

hospital were structured as past mistakes and then resolution, except

that the resolution was often not real.

 

 

 

 

[Guest guest]

Jason

Just another comment which i think clearly contrast the different

state of mind between western and CM thinking and from which CM can

benefit. Hippocrates stated: “Some patients, though conscious that

their condition is perilous, recover their health simply through their

contentment with the goodness of the physician.”

 

 

 

400 29th St. Suite 419

Oakland Ca 94609

 

 

 

alonmarcus

 

 

 

 

 

 

 

 

[Guest guest]

Hi all,

 

Thanks to everyone for their thoughts. Especially to Jason for your

detailed post. What you say seems to jive with what my co-workers tell

me, though I don't have enough experience in China to have seen these

things myself.

 

I also agree that problems with research are not limited to China. I

come from a science background, so I came into school hoping to see

that Chinese medicine could be validated by modern research. However,

the more I learn about the world of research, the more I see it as a

messy can of worms. By no means do I intend to write the whole field

of scientific research off, but it seems like it will play a smaller

role in my decision making and opinion forming process than I thought

it would a few years ago. I was especially impressed by the writing in

this long article in the NY Times Magazine a few months ago. Anyone

else see it?

http://tinyurl.com/5tfm2v

 

And one last follow-up question... Is there anyone out there who

regularly reads Japanese research on herbs or acu? I've only seen

fragments in translation, but it seemed very interesting, and I would

expect a bit more rigor from Japanese academia. Any sources would be

welcome. Nihongo daijobu.

 

All the best,

 

Carl

[Guest guest]

jason

This may be a repeat.

I had by translators bring patients back to look at their little books.

I also ran into patient when they ended up seeing another Dr.

Alon

>

[Guest guest]

The motivations for bad research are universal, the only difference is that with

WM often multi center projects are common and thus a little more difficult to

cheat on, but still occurs. Just look at some claims even done by practitioner

you may know its just human nature, unfortunately.

 

 

 

 

 

 

 

 

 

 

[Guest guest]

Alon,

 

 

 

What you describe sounds different than published written case studies by

famous doctors. In my experience published case studies usally do not give

the patient's full names, therefore I would think it would be almost

impossible to track down patients years later and ask them if they really

got better. I do make a big distinction between published case records by

famous / old physicians and the success stories bandied around in a hospital

setting.

 

 

 

Therefore I assume what you are talking about, is just following up with

patients that have seen a given doctor in a hospital. I also assume that the

doctors said they got better (to you?), and then you realized they had not,

is that correct? I am unsure how there could be so much confusion (with so

many patients) on the outcomes as you describe. If a patient returns for a

follow-up then you can clearly see what has happened. If they do not return

for a follow-up then why would the doctor say they were better, how would

they know? So are you saying that many patients that never returned, yet you

were told that they were cured?

 

 

 

My experience is that you see the patients return over and over and you can

notice the progress (or not). I have never really heard any claims that

patients miraculously were cured that never returned, but I guess this

surely happens. However, maybe I just happen to have worked with doctors

with more integrity(?)

 

 

 

Finally, from you emails it seems like you were unimpressed with the caliber

of these hospital doctors. I have noticed, the best doctors seem to end up

in smaller clinics. In these settings I have seen results (from the patients

themselves) that were mind-blowing. I am sure hospitals also have some good

doctors, but they have many mediocre ones also.

 

 

 

Is this other's experience?

 

 

 

-

 

 

 

 

 

 

 

 

 

_____

 

 

On Behalf Of alonmarcus2003

Monday, May 19, 2008 3:34 PM

 

Re: Research coming out of China

 

 

 

jason

This may be a repeat.

I had by translators bring patients back to look at their little books.

I also ran into patient when they ended up seeing another Dr.

Alon

>

 

 

 

 

[Guest guest]

-Let's go back and look at what we are calling research. Firstly,

there is the issue of how appropriate the standards of WM research is

to the TCM terrain. I think we all agree there are/can be differences

especially when it comes to double blind and undifferentiated

categories of disease. Not to mention the diagnostic issues that

change over time.

Secondly there is semantics, calling improvement, " effective " for

example.

But we can't hide behind the semantics in assessing TCM standards.

Many studies are done in hospitals with a clear agenda of promoting a

patented medicine much in the same way a drug company cooks up a good

looking trial.

Then there are senior doctors who run their own trials probably with

the help of their junior doctors in the same hospitals. Obviously they

want to make themselves look good. There basically isn't much

incentive to make your approach look bad. Especially in China where

TCM holds its own political space within the system. But this is the

same in the West except that we seem to have more, yet perhaps

diminishing, independent researchers who are not tied economic interests.

As far as doctors tooting their own horn for a new a better treatment

or herb, that has been going on forever and will probably continue in

every culture that has some sort of disease.

 

Doug

[Guest guest]

Jason

This was in 1985 there were no small clinics as far as i saw in the big city.

The reason i new the pts was because i was seeing them with him when the cases

were written down. At that time the push to publish, especially for the better

known Drs was great. They basically had to publish.

It is definitely possible that my experience was not representative however

these were Drs with reputations. It was a municipal hospital not a university

hospitals and i do not know if that made a difference at that time. I can tell

you this Dr can recite many classical texts from memory. Sometimes i do wish i

had more time so i can arrange another trip.

 

Alon

 

 

 

[Guest guest]

That is why we need to do much more research. We cannot expect the WM community

to understand how to design good CM clinical research. We can satisfy blinding

in many ways and still allow for CM flexibility. We also need to use more

objective metrics. I have always said that until we have the schools begin to do

some of this work we will not know the information we need to.

Alon